A Simplified Approach to Extravascular Lung Water Assessment Using Point-of-Care Ultrasound in Patients with End-Stage Chronic Renal Failure Undergoing Hemodialysis

Blood Purif. 2018;45(1-3):79-87. doi: 10.1159/000481768. Epub 2017 Dec 7.

Abstract

Background: Fluid overload leading to pulmonary congestion is an important issue in patients undergoing hemodialysis. This study aimed to determine if a simplified method of extravascular lung water assessment using ultrasound provided clinically relevant information.

Methods: This prospective study recruited 47 patients from a single hemodialysis center. Pulmonary ultrasound was performed before and after 2 hemodialysis sessions in 28 regions on the thorax. The B-line score was defined as the percentage regions where B-lines were present.

Results: When B-lines were detected before hemodialysis, a significant relationship was found between fluid removal and the change in B-line score. Patients with a B-line score of ≥21.4% (4th quartile) after the second hemodialysis session were more likely to be hospitalized for pulmonary edema or acute coronary syndrome.

Conclusions: A simplified pulmonary assessment using ultrasound provides relevant information about pulmonary congestion in hemodialysis patients and identifies patients at risk of hospitalization for heart-related problems.

Keywords: B-line artifact; End-stage renal disease; Fluid balance management; Fluid overload; Hemodialysis; Point-of-care ultrasound; Pulmonary edema; Pulmonary ultrasound.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Kidney Failure, Chronic* / diagnostic imaging
  • Kidney Failure, Chronic* / metabolism
  • Kidney Failure, Chronic* / therapy
  • Lung* / diagnostic imaging
  • Lung* / metabolism
  • Male
  • Middle Aged
  • Point-of-Care Systems*
  • Renal Dialysis*
  • Ultrasonography
  • Water / metabolism*

Substances

  • Water