HDCN Article Review/Hyperlink

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 at this site.