Effects of Single Hemodialysis Session on Fluid Status and Spirometric Parameters among Chronic Kidney Disease Patients Attending at Muhimbili National Hospital

Abstract

Background: End-Stage Renal Disease (ESRD) is associated with significant fluid retention, consequently causing fluid overload. This may lead to pulmonary congestion and substantial impairment in lung function. In patients with ESRD, hemodialysis is used to maintain normal fluid and solute status subsequently improving survival and quality of life. It is still not clear whether a single dialysis session can cause a substantial fluid reduction and acutely improve spirometric parameters Objective: We aimed at assessing Effects of single hemodialysis session on fluid status and spirometric parameters among Chronic Kidney Disease patients attending at Muhimbili National Hospital. Methodology: Forty-five (45) consecutively recruited patients with ESRD were prospectively followed during dialysis sessions. Fluid status was assessed using a Multifrequency bioelectrical impedance analysis (BIA) device, before and after 4 hours of dialysis. At the same time points, we also assessed sprirometric parameters using a digital spirometer. Data analysis was carried out using the Statistical Package for Social Sciences (SPSS), Version 23. We found a significant decrease (p <0.001) in total body water (TBW) from 43.9± 6.3 SD to 40.1 ± 6.3, extracellular water (ECW) from19.4±2.6 SD to 17.8±2.4 SD intracellular water (ICW) from 22.2± 3.3 SD to 20.9±3.2, third space water (TSW) from 2.3±1.9 to 1.6±1.7. Despite reductions in fluids from all the compartments, the majority of patients (66%) did not attain a normal hydration status following a single dialysis session. There was a significant improvement of Forced Vital Capacity (FVC) and the percentage predicted FVC among females after single hemodialysis but not among males. However, we found no significant changes in other spirometry parameters such as Forced Expiratory Volume in one second (FEV1) Peak Expiratory Flow (PEF), Ratio of FEV1/FVC, and Forced Expiratory Flow (FEF 25-75) together with their percentage predicted values respectively after a single dialysis session in both females and males. There was a significant reduction of fluids in all body compartments. However there was no improvement in spirometric parameters following a single hemodialysis session possibly due to fluid overload that persisted even after the dialysis session Recommendation Monitoring hydration status before and after hemodialysis could be beneficial in normalizing the fluid status, and possibly bring improvement of the spirometric parameters among CKD patients. Therefore, follow-up studies on the effect of subsequent dialysis sessions with normalization of fluid status and spirometry are warranted