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Pulmonary Diffusion Capacity for Carbon Monoxide (DLCO) in Indonesian Patients with End-stage Renal Disease
Objectives: End-stage renal disease affects all systems in human including the respiratory system. This study aimed to discover the lung diffusion capacity of carbon monoxide (DLCO) in chronic hemodialysis patients and to establish its relation to several demographic and clinical factors as well as spirometry parameters.
Materials and Methods: This was a cross-sectional study among chronic hemodialysis patients aged ≥18 years, clinically stable in the last four weeks, without prior history of lung and cardiac disorder. Spirometry and DLCO examination were performed in the span of 24 hours after hemodialysis.
Outcomes: There were 40 subjects analyzed. Majority of them were males (67.5%), non-smokers (55%), with a median age of 51 years, a mean body mass index of 22.6±3.9 kg/m2, a hemoglobin level of 9.5±1.3 g/dL, a median dialysis adequacy of 1.62 and a hemodialysis duration of 31.5 months. Hypertension was the most common underlying disease. About 20% of subjects had varying degrees of dyspnea. Prevalence of DLCO reduction was 52.5% with mild to moderate degree. Restrictive spirometry pattern was evident in 47.5% of subjects and obstructive pattern in 5%. There was a significant relation between DLCO reduction with smoking history (OR 4.52 [95% CI 1.04–19.6]) and also with restrictive disorder [OR 5.5 (95% CI 1.29–23.8)]. We suspected a lung parenchymal disorder as the cause of lung restriction and diffusion inhibition.
Conclusion: Reduction of lung diffusion capacity in chronic dialysis patients is common, although not accompanied by dyspnea. Risk factors for DLCO reduction are smoking history and restrictive disorder in spirometry.
Keywords: pulmonary diffusion capacity, end-stage renal disease, hemodialysis