Why Is Your Patient Still Short of Breath? Understanding the Complex Pathophysiology of Dyspnea in Chronic Kidney Disease.
Dyspnea is one of the most common symptoms associated with CKD. It has a profound influence on the quality of life of CKD patients, and its underlying causes are often associated with a negative prognosis. However, its pathophysiology is poorly understood. While hemodialysis may address fluid overload, it often does not significantly improve breathlessness, suggesting multiple and co-existing alternative issues exist. The aim of this article is to discuss the main pathophysiologic mechanisms and the most important putative etiologies underlying dyspnea in CKD patients. Congestive heart failure, unrecognized chronic lung disease, pulmonary hypertension, lung fibrosis, air microembolism, dialyzer bio-incompatibility, anemia, sodium, and fluid overload are potential frequent causes of breathing disorders in this population. However, the relative contributions in any one given patient are poorly understood. Systemic inflammation is a common theme and contributes to the development of endothelial dysfunction, lung fibrosis, anemia, malnutrition, and muscle wasting. The introduction of novel multimodal imaging techniques, including pulmonary functional magnetic resonance imaging with inhaled contrast agents, could provide new insights into the pathophysiology of dyspnea in CKD patients and ultimately contribute to improving our clinical management of this symptom.
Department of Medicine and Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada.
Fabio Rosario
FR
Salerno
Department of Medicine and Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada.|Robarts Research Institute, The University of Western Ontario, London, Canada.
Grace
G
Parraga
Department of Medicine and Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada.
Christopher William
CW
McIntyre
D018450:Disease Progression; D004417:Dyspnea / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D004618:Embolism, Air / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D011379:Prognosis; D011654:Pulmonary Edema / Q000209:etiology / Q000503:physiopathology; D011655:Pulmonary Embolism / Q000209:etiology / Q000503:physiopathology; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate