The effect of kidney replacement therapy on lung mechanics and respiratory function: A systematic review and meta-analysis.

Abstract

Background: Given the substantial overlap between renal and pulmonary systems, understanding the role of kidney replacement therapy (KRT) in alleviating respiratory complications is essential for managing patients with concurrent kidney and lung dysfunction. This study evaluated the impact of KRT, including hemodialysis and peritoneal dialysis, on lung mechanics and respiratory function, especially in critically ill patients on mechanical ventilation.

Methods: PubMed, Cochrane, Scopus, and Web of Science were searched up to October 8, 2024. Studies were selected using prespecified criteria and analyzed using R. Heterogeneity was assessed with the I² test; study quality was evaluated using ROBINS-IV2. This project is registered in PROSPERO with ID CRD420251106970.

Results: Seven studies (10 cohorts, 436 patients; 59.4 % male; mean age 49.5-73.2) were included. KRT significantly improved static lung compliance (MD 10.34; 95 % CI 5.46-15.41; p < 0.01), especially with PD in ICU patients (MD 17.20; 95 % CI 10.54-23.86; p < 0.01). No significant effects were found on dynamic compliance, respiratory resistance, or most pulmonary indices. Oxygenation showed a borderline improvement (MD 41.20; 95 % CI 0.62-81.78; p = 0.05).

Conclusion: This review highlights the potential benefits of KRT in improving static lung compliance in ICU patients, especially with PD. However, improvements in oxygenation efficiency remain limited and inconsistent, likely due to the complexities of critical care factors. The lack of adequate reporting on potential mediators of KRT's impact on pulmonary function prevents us from drawing firm conclusions.