Kidney Week

Abstract: TH-PO196

Lung Ventilation Abnormalities in Chronic Hemodialysis Patients with Hyperpolarized ¹²⁹Xe Gas Magnetic Resonance Imaging

Session Information

• Hemodialysis and Frequent Dialysis - I
  November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Salerno, Fabio R., Western University, London, Ontario, Canada

Fabio R. Salerno,

• Eddy, Rachel, Western University, London, Ontario, Canada

Rachel Eddy,

• Matheson, Alexander M., Western University, London, Ontario, Canada

Alexander M. Matheson,

• Parraga, Grace, Robarts Research Institute, Western University, London, Ontario, Canada

Grace Parraga,

• McIntyre, Christopher W., London Health Sciences Centre, London, Ontario, Canada

Christopher W. McIntyre,

Background

Shortness of breath is common among chronic HD patients, usually attributed to congestive heart failure and volume overload. However, it may be the hallmark of an underlying lung airway disease, such as asthma or COPD, which are often undiagnosed and there may be unique pathomechanisms in dialysis patients (e.g. salt loading). In this study, we used inhaled hyperpolarized xenon-129 (¹²⁹Xe) gas magnetic resonance imaging (MRI) to directly measure lung ventilation abnormalities in prevalent HD patients.

Methods

Ten chronic HD patients underwent ¹H and ¹²⁹Xe lung MRI on a non-HD day. ¹²⁹Xe MRI was acquired during breath-hold at end-inspiration, after inhalation of a fixed volume of hyperpolarized ¹²⁹Xe, and co-registered with proton images with matching lung volumes. Patients were scanned before and after administration of salbutamol to evaluate reversibility. Static ventilation ¹²⁹Xe images were analyzed with a semiautomated software pipeline implemented in Matlab (2018b; Mathworks, Natwick MA) to calculate the ventilation defect percent (VDP).

Results

In the study sample, three main ventilation patterns were identified: Normal, Single Defect, Multiple Defects (Figure 1A). Partial ventilation improvement after salbutamol administration was also observed (Figure 1B).

Conclusion

Underlying lung airway diseases as detected by ¹²⁹Xe lung MRI are common and may help explain the pathophysiology of shortness of breath in prevalent HD patients.

Figure 1. (A) ¹²⁹Xe MRI ventilation images showing three ventilation patterns: Normal, Single Defect and Multiple Defects. (B) ¹²⁹Xe MRI ventilation images showing partial improvement after salbutamol administration.