SYSTEMATIC REVIEW article
Front. Physiol.
Sec. Respiratory Physiology and Pathophysiology
Effect of Hemodialysis in End-Stage Renal disease patients on Pulmonary Function Tests: A Meta-Analysis of Cross-sectional Studies
Provisionally accepted
- 1Emergency Department, Jiashan County First People's Hospital, Jiaxing, China
- 2Department of Psychiatry, Third People's Hospital, Jiashan County, Jiaxing, China
- 3Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
- 4Department of ICU, University of South China Affiliated Nanhua Hospital, Hengyang, China
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Background: Hemodialysis, the principal therapy for end-stage renal disease (ESRD), directly influences pulmonary mechanics by alleviation of fluid overload and uremic toxin accumulation. Hemodialysis (HD), the main renal replacement therapy, removes excess volume and solutes, but its acute effects on pulmonary function remain uncertain. This meta-analysis evaluates impact of hemodialysis on pulmonary function and examines pre-to post-dialysis changes in spirometric parameters among ESRD patients. Methods: We conducted meta-analysis of cross-sectional studies that measured pulmonary function in ESRD patients on maintenance hemodialysis. Data from 16 eligible studies (n = 719 patients) were synthesized. Our analysis was focused on changes in forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), FEV₁/FVC ratio, forced expiratory flow at 25-75% (FEF₂₅₋₇₅), and peak expiratory flow rate (PEFR). Statistical analysis was performed using random-effects models to calculate pooled mean differences (MD) for spirometric outcomes. Results: Hemodialysis was associated with significant improvements in percent-predicted FEV₁(+8.99%) and FVC(+12.87%), while absolute changes in these parameters were small and not statistically significant. The FEV₁/FVC ratio and PEFR also improved in percent-predicted terms. Sensitivity analyses confirmed stability of results, though high heterogeneity (I²>75%) was observed for several outcomes. Publication bias was minimal, with Egger's and Begg's tests indicating no significant asymmetry, except for borderline Begg's p-value for FVC (%pred). These improvements likely reflect ultrafiltration-mediated relief of pulmonary congestion and modulation of uremic milieu. Conclusion: Hemodialysis acutely mitigates renal failure-related pulmonary restriction, with percent-predicted spirometry showing consistent gains. These effects highlight role of dialysis prescriptions and fluid management strategies in optimizing respiratory as well as renal outcomes.
Keywords: Chronic Kidney Disease, end-stage renal disease, hemodialysis, Pulmonary Function, Spirometry, Meta-analysis
Received: 24 Sep 2025; Accepted: 20 Nov 2025.
Copyright: © 2025 Zhang, Xu, Huang, Jiang, Jiang and Wu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Huichao Wu, 15706711576@163.com
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