Management of Wheezing in Hemodialysis Patients Without Fluid Overload

Immediate Assessment and Medication Review

• The American Thoracic Society suggests that ACE inhibitors, which compete for ACE binding sites in the lungs, commonly trigger respiratory symptoms in dialysis patients, and should be reviewed and considered for discontinuation 1, 2, 3
• Beta-adrenergic blocking agents may exacerbate asthma by triggering bronchoconstriction in dialysis patients, and should be assessed 1, 2, 3

Assess for Underlying Pulmonary Disease

• The American College of Chest Physicians recommends that wheezing in dialysis patients with self-reported allergy history be evaluated, as it is significantly more frequent in this population (44% vs 16% in those without cough) 1, 2, 3
• Symptoms consistent with asthma are more common in dialysis patients with respiratory complaints (40% vs 16%), and standard bronchodilator therapy should be initiated if asthma is confirmed 1, 2

Confirm Absence of Volume Overload

• Clinical examination, including blood pressure, edema, jugular venous pressure, and lung examination, should be used to verify the absence of fluid overload in dialysis patients, as recommended by the European Renal Association 4
• Fluid overload is easily underestimated in dialysis patients and commonly contributes to respiratory symptoms, according to the British Thoracic Society 5

Additional Considerations

• The Centers for Disease Control and Prevention recommend that dialysis patients be evaluated for infectious causes of respiratory symptoms, including tuberculosis, due to relative immunosuppression 1, 2, 3