Diaphragmatic Dysfunction Contributes To Dyspnoea,Fatigue,and Snoring In Haemodialysis Patients

Background: Muscle wasting is associated with increased mortality and morbidity in chronic kidney disease(CKD)patients,especially in the haemodialysis(HD)population.Little is known regarding diaphragmatic dysfunction under CKD conditions.Methods: We conducted a cross-sectional study at the Institute of Nephrology,Southeast University,involving 103 HD patients and 103 healthy volunteers as normal control.Ultrasonography was used to evaluate diaphragmatic function,including diaphragm thickness and excursion.We further examined the prevalence of diaphragmatic dysfunction and its influence factor and relationship with debilitating symptoms(dyspnoea,hiccups,and fatigue)in HD patients.Results: A total of 206 participants were enrolled.HD patients showed lower endinspiration thickness of the diaphragm at total lung capacity(0.386 ± 0.144 vs.0.439 ± 0.134 cm,p < 0.01)and TF(0.838 ± 0.618 vs.1.127 ± 0.757;p < 0.01)compared to controls.The velocity and excursion of the diaphragm were significantly lower in the HD patients during deep breathing(3.686 ± 1.567 vs.4.410 ± 1.720 cm/s,p < 0.01;5.290 ± 2.048 vs.7.232 ± 2.365 cm;p < 0.05).Changes in diaphragm displacement from quiet breathing to deep breathing(?m)were lower in HD patients than in controls(2.608 ± 1.630 vs.4.628 ± 2.110 cm;p < 0.01).After multivariate adjustment,hemoglobin level may have effects on diaphragmatic functions such as DMTLC and ?m(r = 0.022,p < 0.05 and r = 0.022,p < 0.01).Diaphragm thickness during deep breathing was positively correlated with weight and was greater in males than in females.We also found that the incidence of dyspnoea and snoring and the fatigue scores,all of which were related to diaphragmatic dysfunction,were significantly higher in HD patients than in controls(all p < 0.01).Conclusion: Diaphragmatic dysfunction could be easily evaluated by ultrasonography and was found to be common in HD patients.Improving diaphragm function through targeted therapies may positively impact clinical outcomes in HD patients.