Impact Of Hypoxemia In Patient With Chronic Obstructive Pulmonary Disease On Renal Function Tests

Amjed Hassan Abbas,Samir Sawadi Hammuod
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Keywords : COPD, blood urea, serum creatinine, creatinine clearance
Medical Journal of Babylon  14:1 , 2017 doi:1812-156X-14-1
Published :17 July 2017

Abstract

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases and is expected to be progressively increasing. There are many co-morbidities associated with it, but the relation between it and changes in renal function tests is still unclear. The aim of this work was to illustrate the extent of kidney dysfunction in patients who suffer from COPD. This study was performed in Merjan Medical City, the period of study was from November 2013 to June 2014, it included 86 patients with COPD and 70 control healthy subjects who completed medical questionnaires, pulmonary function tests and measurement of blood urea and serum creatinine. The data was statistically analyzed, the level of statistical significance that was depended for this study was P values ?0.05. The results of this study revealed significant difference in the mean values of blood urea (Bur), serum creatinine (Scr), and creatinine clearance (Ccr) before and after treatment for all patients, Bur increased and Ccr decreased significantly in hypoxic group in comparison with non hypoxic group (P ? 0.05); while no significant changes in Scr (P = 0.1). In addition, the study showed a significant correlation between blood urea and creatinine clearance (Ccr) with SPO2 (before treatment) (p < 0.05), while non-significant negative correlation between serum creatinine and SPO2 (before treatment) (r = 0.1, P > 0.05).The results illustrated that the Bur and Scr increased; while Ccr decreased significantly in male group in comparison to female group (P?0.05). Also there was no significant correlation between blood urea, serum creatinine, and creatinine clearance with forced expiratory volume in first second (FEV1) (before treatment) (P > 0.05). From this study, we conclude that abnormalities of renal function tests are common in patients with COPD at the first days of admission to hospital.

Introduction

The alterations in the blood oxygen (O2) and carbon dioxide (CO2) can affect kidneys hemodynamic and these are well-known in patients with chronic obstructive pulmonary disease (COPD), mostly in severe exacerbation [1,2]. Chronic obstructive pulmonary disease is a heterogeneous disease associated with multiple co-morbidities [3]. It has been reported that the prevalence of kidney dysfunction is increased in those with COPD, some of the smoking components like nicotine and selected heavy metals can be considered as risk factors for renal diseases [4]. serum creatinine was used to diagnose chronic renal failure and therefore there was underestimation for its prevalence [5]. Studying the relation between renal function and COPD is important because the disease is highly prevalent and there is significant morbidity, mortality, and cost associated with kidney failure and kidney replacement therapy [6]. COPD represents one of the sources of systemic inflammation which is not only restricted to the lungs and can extend systemically [7]. It is known to cause cardiovascular diseases. But there was little information regarding the relation between it and renal dysfunction [8]. This work aimed to determine the extent of changes in renal function in patients with COPD.

Materials and methods

This study was performed in Medical City of Merjan in Babylon Province during the period from November 2013 to June 2014, the study involved 86 patients with history of  COPD for more than six months who were admitted in the ward due to acute exacerbations and they were compared with 70 control healthy subjects. Full history (age, gender, duration of disease, smoking and chronic diseases), with complete physical examination were done for all the patients and control subjects. The following investigations were done for patients and controls: electrocardiography, echocardio-graphy, chest x-ray, random blood sugar, renal function tests, pulmonary function tests, and liver function tests. Pulmonary function testing was accomplished depending on the recommendations of the American Thoracic Society and measured values were compared with standard population-derived predicted values. Exclusion criteria were as follows: asthma, bronchiectasis, inability to perform spirometry or if they had a restrictive pattern on spirometry, other significant lung disease, previous kidney or cardiovascular diseases, prior thoracic surgery, or a body mass index (BMI) > 35 kg/m2.
Statistical Analysis
   The data was analyzed by using the Statistical Package for the Social Sciences (SPSS version 18). For the comparisons the mean between the two groups, we used Student’s ‘t’ test while for analyzing categorical data, Chi square test was used. For all tests p ? 0.05 was taken as the level of statistical significance. Regarding the relation between some parameters, simple linear regression was used [9].




Results

The mean age of patients (active group) were 62.03±9.07 years, duration of symptoms ranged from six months to 10 years with mean 4.19±2.82 years. Patient with increased blood urea and serum creatinine were older in age, male, and had lower BMI, lower PCV, and they smoke more than other patients. Patients with increased blood urea account for the largest percentage of patients in reverse to the increased serum creatinine with significant difference between active and control groups as shown in table (1).

Discussions

In this study, there was clinical and statistical significant reduction in kidney function with worsening hypoxia. The mechanisms that link COPD and kidney function are at present speculative [10]. COPD can produce right ventricular volume overload by increasing pulmonary vascular resistance leading to reduced cardiac output and kidney perfusion with resulting reductions in GFR [11]. Another explanation could be a cellular or immune complex mediated systemic inflammatory response in patients with emphysema. Such an inflammatory response can lead to kidney dysfunction either directly or by induction of endothelial dysfunction [12,13]. Studies on normal subjects have generally shown an increase in renal blood flow (RBF) with moderate acute hypoxemia, probably because of increased catecholamine concentrations and cardiac output. Paradoxically, RBF is low in chronic hypoxemia as in patients with COPD despite of normal or even increased [14]. In this study, there was association between hypoxemia and disturbed renal function but this might be not the only cause because not all patients with hypoxemia had renal dysfunction, other factors may play a role like some nephrotoxic drugs used in the treatment of COPD especially third generation cephalosporins given during acute exacerbations. The study showed that creatinine clearance is better than serum creatinine in assessment of renal function in patients with COPD because serum creatinine can be affected by fat-free mass and muscle turnover and some of patients with this disease have a reduced muscular mass, so the serum creatinine may be falsely low because of reduced creatinine release [15].

Conclusions

Renal dysfunction should be taken in consideration in patients with COPD, even with normal serum creatinine, because its presence either have prognostic implications on the disease itself or affect clinical practice (eg, drug prescribing and dosing).

References

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9. Wayne, W.D. (1999). Biostatistics a foundation for analysis in the health sciences. 7th edition. John Wiley and sons, INC.USA.186-188.

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