ASSESSMENT OF RESPIRATORY MUSCLE STRENGTH IN PATIENTS WITH CHRONIC KIDNEY DISEASE ON MAINTENANCE HEMODIALYSIS- A CROSS-SECTIONAL STUDY

Abstract

Introduction: Chronic kidney disease (CKD) is a global public health issue, with rising incidence and prevalence, high expenditures, and poor results. Kidney Disease Improving Global Outcomes (KDIGO) is a newly formed and independently incorporated organization and its stated mission is to “improve the care and outcomes of kidney disease patients worldwide by promoting coordination, collaboration, and integration of initiatives to develop and implement clinical practice guidelines.” According to KDIGO guidelines CKD is characterized by kidney damage for 3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased glomerular filtration rate (GFR). Respiratory muscle dysfunction is a cardinal feature in chronic kidney disease (CKD) contributing to decreased exercise capacity and pulmonary function limitation with the progression of the disease. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) are reliable parameters for assessing respiratory muscle strength. Detecting any respiratory muscle weakness gives scope to start physiotherapeutic interventions in that direction and there is very minimal literature about the same in our Indian context and globally also.

Objective: To determine the respiratory muscle strength in patients with chronic kidney disease on maintenance hemodialysis.

Methodology: Data was collected from the dialysis center of MS Ramaiah Medical College, Bengaluru. Stage-5D chronic kidney disease patients diagnosed by the physician and patients on maintenance hemodialysis for more than 3 months undergoing 3 times per week were included in the study. Patients with Recent Myocardial infarction in the last 6 months, chronic respiratory disorders, and patients with an Ejection fraction of 35% were excluded from the study.

Results: The median and interquartile range were found to be 35(23, 52) cm H₂0 and 46(31, 53) cm H₂0 of MIP and MEP respectively.

Conclusion: MIP and MEP were found to be 35(23, 52) cm H₂0 and 46(31, 53) cm H₂0 and can be used as a reference for comparison with the normative values and respiratory muscle training can be included with the pulmonary rehabilitation program.