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Restrictive lung disorder is common in patients with kidney failure and associates with protein-energy wasting, inflammation and cardiovascular disease

BACKGROUND: Cardiovascular disease (CVD), protein-energy wasting (PEW), and inflammation are common interrelated features of chronic kidney disease (CKD). Less is known about lung dysfunction in CKD and its possible role in this context. We evaluated lung function and its association with estimated...

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Autores principales: Mukai, Hideyuki, Ming, Pei, Lindholm, Bengt, Heimbürger, Olof, Barany, Peter, Anderstam, Björn, Stenvinkel, Peter, Qureshi, Abdul Rashid
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922538/
https://www.ncbi.nlm.nih.gov/pubmed/29702682
http://dx.doi.org/10.1371/journal.pone.0195585
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author Mukai, Hideyuki
Ming, Pei
Lindholm, Bengt
Heimbürger, Olof
Barany, Peter
Anderstam, Björn
Stenvinkel, Peter
Qureshi, Abdul Rashid
author_facet Mukai, Hideyuki
Ming, Pei
Lindholm, Bengt
Heimbürger, Olof
Barany, Peter
Anderstam, Björn
Stenvinkel, Peter
Qureshi, Abdul Rashid
author_sort Mukai, Hideyuki
collection PubMed
description BACKGROUND: Cardiovascular disease (CVD), protein-energy wasting (PEW), and inflammation are common interrelated features of chronic kidney disease (CKD). Less is known about lung dysfunction in CKD and its possible role in this context. We evaluated lung function and its association with estimated glomerular filtration rate (GFR), CVD, PEW, and inflammation in individuals with normal to severely reduced GFR. METHODS: In 404 individuals with GFR category G1 (n = 31; GFR >90mL/min/1.73 m(2)), G2 (n = 46), G3 (n = 33), G4 (n = 49) and G5 (n = 245; GFR<15mL/min/1.73 m(2)), pulmonary function was assessed by spirometry. Obstructive (OLD) and restrictive (RLD) lung dysfunction was defined based on forced vital capacity (FVC), forced expiratory volume in the first second (FEV(1)) and peak expiratory flow (PEF), expressed as percentages of predicted values (%FEV(1), %FVC and %PEF, respectively). PEW was evaluated by subjective global assessment, handgrip strength (HGS) and lean body mass index (LBMI), and inflammation by interleukin-6 and high sensitivity C-reactive protein. RESULTS: RLD (defined as FEV(1)/FVC ≥ 0.70 and %FVC<80) associated with GFR and was present in 36% of G5 and 14% of G1-4 individuals. OLD (FEV(1)/FVC<0.70) was less common with similar prevalence among G1-4 (9%) and G5 (11%) individuals. Notably, 64% of those with concomitant presence of PEW, inflammation and clinical signs of CVD had RLD while 79% of those lacking these complications had normal lung function. In multivariate logistic regression analysis, RLD associated with CVD, PEW and inflammation, after adjusting for Framingham’s CVD risk score, serum albumin, and GFR category. CONCLUSIONS: RLD is a common complication in patients with advanced CKD, especially in those with concomitant presence of CVD, inflammation and PEW. RLD appears to be an integral albeit scarcely explored consequence of pulmonary-renal interactions in CKD patients.
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spelling pubmed-59225382018-05-11 Restrictive lung disorder is common in patients with kidney failure and associates with protein-energy wasting, inflammation and cardiovascular disease Mukai, Hideyuki Ming, Pei Lindholm, Bengt Heimbürger, Olof Barany, Peter Anderstam, Björn Stenvinkel, Peter Qureshi, Abdul Rashid PLoS One Research Article BACKGROUND: Cardiovascular disease (CVD), protein-energy wasting (PEW), and inflammation are common interrelated features of chronic kidney disease (CKD). Less is known about lung dysfunction in CKD and its possible role in this context. We evaluated lung function and its association with estimated glomerular filtration rate (GFR), CVD, PEW, and inflammation in individuals with normal to severely reduced GFR. METHODS: In 404 individuals with GFR category G1 (n = 31; GFR >90mL/min/1.73 m(2)), G2 (n = 46), G3 (n = 33), G4 (n = 49) and G5 (n = 245; GFR<15mL/min/1.73 m(2)), pulmonary function was assessed by spirometry. Obstructive (OLD) and restrictive (RLD) lung dysfunction was defined based on forced vital capacity (FVC), forced expiratory volume in the first second (FEV(1)) and peak expiratory flow (PEF), expressed as percentages of predicted values (%FEV(1), %FVC and %PEF, respectively). PEW was evaluated by subjective global assessment, handgrip strength (HGS) and lean body mass index (LBMI), and inflammation by interleukin-6 and high sensitivity C-reactive protein. RESULTS: RLD (defined as FEV(1)/FVC ≥ 0.70 and %FVC<80) associated with GFR and was present in 36% of G5 and 14% of G1-4 individuals. OLD (FEV(1)/FVC<0.70) was less common with similar prevalence among G1-4 (9%) and G5 (11%) individuals. Notably, 64% of those with concomitant presence of PEW, inflammation and clinical signs of CVD had RLD while 79% of those lacking these complications had normal lung function. In multivariate logistic regression analysis, RLD associated with CVD, PEW and inflammation, after adjusting for Framingham’s CVD risk score, serum albumin, and GFR category. CONCLUSIONS: RLD is a common complication in patients with advanced CKD, especially in those with concomitant presence of CVD, inflammation and PEW. RLD appears to be an integral albeit scarcely explored consequence of pulmonary-renal interactions in CKD patients. Public Library of Science 2018-04-27 /pmc/articles/PMC5922538/ /pubmed/29702682 http://dx.doi.org/10.1371/journal.pone.0195585 Text en © 2018 Mukai et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Mukai, Hideyuki
Ming, Pei
Lindholm, Bengt
Heimbürger, Olof
Barany, Peter
Anderstam, Björn
Stenvinkel, Peter
Qureshi, Abdul Rashid
Restrictive lung disorder is common in patients with kidney failure and associates with protein-energy wasting, inflammation and cardiovascular disease
title Restrictive lung disorder is common in patients with kidney failure and associates with protein-energy wasting, inflammation and cardiovascular disease
title_full Restrictive lung disorder is common in patients with kidney failure and associates with protein-energy wasting, inflammation and cardiovascular disease
title_fullStr Restrictive lung disorder is common in patients with kidney failure and associates with protein-energy wasting, inflammation and cardiovascular disease
title_full_unstemmed Restrictive lung disorder is common in patients with kidney failure and associates with protein-energy wasting, inflammation and cardiovascular disease
title_short Restrictive lung disorder is common in patients with kidney failure and associates with protein-energy wasting, inflammation and cardiovascular disease
title_sort restrictive lung disorder is common in patients with kidney failure and associates with protein-energy wasting, inflammation and cardiovascular disease
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922538/
https://www.ncbi.nlm.nih.gov/pubmed/29702682
http://dx.doi.org/10.1371/journal.pone.0195585
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