PMID: 2805844Nov 1, 1989

Pulmonary gas exchange during dialysis in patients with obstructive lung disease

Chest
W D PitcherW L Henrich

Abstract

Hypoxemia occurs during routine hemodialysis and may contribute to morbidity, but its cause is not well understood. We reasoned that patients with COPD would be more vulnerable to abnormalities in gas exchange with dialysis. Thus, to investigate the cause of dialysis-related hypoxemia, we measured gas exchange in a group of stable dialysis patients with normal pulmonary function (n = 6) and a group of dialysis patients with COPD (n = 6). Measurements were made predialysis, at 1 h, and postdialysis with both acetate and bicarbonate dialysates. Acetate dialysis decreased PaO2 in normal and COPD patients at 1 h and postdialysis. Acetate-induced hypoxemia was associated with reduced respiratory CO2 excretion and hypoventilation but PaCO2 did not change. This decrease in CO2 excretion resulted from CO2 fixation during acetate metabolism and modest CO2 loss across the dialyzer. Hypoxemia occurred only postdialysis with bicarbonate dialysate in normal and COPD patients. An increased P(A-a)O2 occurred postdialysis with both dialysates, and was most consistently observed in the COPD patients. In summary, at least two mechanisms contribute to dialysis hypoxemia. With acetate dialysate, alveolar hypoventilation from CO2 unloading occurs a...Continue Reading

References

Oct 20, 1977·The New England Journal of Medicine·N M AurigemmaE G Lowrie
Apr 7, 1977·The New England Journal of Medicine·P R CraddockH S Jacob
Jan 1, 1986·Nephron·R Peces SerranoJ Alvarez Grande
Apr 1, 1988·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·M CardosoL Lapierre
Jan 1, 1984·American Journal of Nephrology·D K Abu-HamdanF D McDonald
Jul 9, 1981·The New England Journal of Medicine·M J DolanK Wasserman
May 1, 1983·Kidney International·W A De BackerM E De Broe
Jan 1, 1982·American Journal of Nephrology·A R EiserM S Neff

Citations

Jan 1, 1992·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·J U Leititis, M Brandis
Jan 9, 2010·Critical Care : the Official Journal of the Critical Care Forum·Roberto Alberto De BlasiPaolo Menè
Apr 12, 2013·Nephro-urology Monthly·Ali MomeniMasoud Amiri
Apr 8, 2015·Seminars in Dialysis·Jagannath H Saikumar, Csaba P Kovesdy
Sep 29, 2020·American Journal of Physiology. Renal Physiology·Justin D SprickJeanie Park
Nov 25, 2016·Journal of the American Society of Nephrology : JASN·Matthew K Abramowitz

Related Concepts

Acetic Acids
Anoxemia
Carbonic Acid Ions
Hemodialysis
Kidney Failure, Chronic
Lung Diseases, Obstructive
Pulmonary Gas Exchange
Dialysis Solutions

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