Respiratory Muscle Weakness in Uremic Patients under Continuous Ambulatory Peritoneal Dialysis

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Abstract
The increasingly frequent use of continuous ambulatory peritoneal dialysis (CAPD) as substitutive therapy in terminal renal failure has induced the investigation of the advantages and disadvantages of this therapeutic modality. The effects of CAPD on pulmonary function are one of the aspects currently under study. Based on previous data suggesting the existence of extrapulmonary ventilatory restriction in uremic patients under CAPD, respiratory muscle function as expresssed in the maximal inspiratory pressure (MIP) and impact of the infusion of 2 l of dialysis fluid into the peritoneal cavity on both MIP and the pulmonary volumes were assessed. Uremic patients evidenced significantly lower MIP values as compared with healthy controls. The filling of the peritoneal cavity induced, both in the supine and in the sitting position, a restrictive effect and an increase in the inspiratory capacity. Uremic patients under CAPD evidence a respiratory muscle dysfunction of as yet unclear cause. Apparently, the infusion of 2 l of dialysis fuid into the peritoneal cavity induces not only a restrictive effect, but also an increase in the strength of the respiratory muscles, the latter effect being probably due to increased diaphragmatic contractility.

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