Impact of Hemodialysis versus Hemodiafiltration on Pulmonary Functions in Pediatric End Stage Renal Disease.

Hassan, Ahmed Hussein; El Saify, Magda Yehia; Hussein, Sherif Moawaad; Hussein, Mahitab Morsi

doi:10.21608/geget.2025.441013

Impact of Hemodialysis versus Hemodiafiltration on Pulmonary Functions in Pediatric End Stage Renal Disease.

Document Type : Original Article

Authors

¹ Nephrology and Dialysis Unit, Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

² Pulmonology Unit, Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

³ Ministry of Health and Population, Cairo, Egypt.

10.21608/geget.2025.441013

Abstract

Introduction: End-stage renal disease (ESRD) impacts the pulmonary system through hemodynamic instability, endothelial injury, accumulation of toxins, and uremia.
Aim of the study: This study aims to measure pulmonary functions using spirometry and serum endothelin-1 levels among pediatric patients with ESRD before and after dialysis using different hemodialysis modalities.
Methods: This study included fifteen patients on regular conventional hemodialysis and fifteen age and gender-matched patients on regular hemodiafiltration. Serum endothelin-1 levels were measured one hour before and after dialysis sessions. Patients underwent pulmonary function examinations using spirometry to measure the forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) to determine the pattern of pulmonary affection.
Results: There was a significant difference in endothelin-1 levels between both groups before dialysis sessions; however, it became insignificant after dialysis (p = 0.03, p = 0.07, respectively). Pulmonary function tests (PFT) revealed restrictive lung disease in 73.3% of patients on hemodialysis and 60% of patients on hemodiafiltration. Spirometry readings and the pattern of lung affection were comparable between the two studied groups. Endothelin-1 levels significantly increased post-dialysis in both groups (p < 0.001) and were higher in the hemodialysis group pre-dialysis (p = 0.03). There was a negative correlation between the duration of dialysis and endothelin-1 levels and PFT parameters in both groups. Endothelin-1 levels were negatively correlated with pre-dialysis PFT parameters (p < 0.05).
Conclusion: Pediatric patients with ESRD on either conventional hemodialysis or hemodiafiltration can suffer from silent restrictive lung disease. Routine PFT is recommended for patients on regular dialysis.

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