Wallin CJB, Jacobson SH, Leksell LG
Subclinical pulmonary edema and intermittent hemodialysis
Nephrol Dial Transplant
(Nov) 11:2269-2275 1996
The existence and clinical importance of lung water accumulation in
HD patients during the interdialytic patients has been the subject
of several studies in the past. Evidence of excess lung fluid has
included premature airway closure reversible with dialysis and
improved V/Q ratio in response to dialysis.
IN this study, a new double indicator dilution technique involving
heavy water and indocyanine green was used to assess central blood
volume. Briefly, the indicator is injected into the venous limb of
the fistula, and samples are taken from the arterial limb to
compute cardiac output and transit time. Lung water is computed as
cardiac output multiplied by the difference between the transit
time of heavy water and of indocyanine green.
Lung water fell during all treatments, with a marked rebound by 2h
after dialysis. There was no relation between change in lung water
and change in body weight, cardiac output, or central blood volume.
The results were taken to indicate "subclinical pulmonary edema"
predialysis in dialysis patients, as measurements of lung water
predialysis were about 33% higher than that in a non-uremic control
group of patients. It was concluded that this increase in lung
water had only a marginal effect on gas exchange.
Comment: The paper is interesting mostly from a technical
standpoint, as it is obvious that lung water must be increased in
HD patients predialysis. Further studies may begin to show
differences among patients, correlations with cardiac function,
serum albumin, etc.
(John T. Daugirdas, M.D., University of Illinois at Chicago)
The full text of this abstract is available from Oxford Press