A randomized multicenter trial on a lung ultrasound–guided treatment strategy in patients on chronic hemodialysis with high cardiovascular risk

Zoccali, Carmine; Torino, Claudia; Mallamaci, Francesca; Sarafidis, Pantelis; Papagianni, Aikaterini; Ekart, Robert; Hojs, Radovan; Klinger, Marian; Letachowicz, Krzysztof; Fliser, Danilo; Seiler-Mußler, Sarah; Lizzi, Fabio; Wiȩcek, Andrzej; Miśkiewicz, Agata; Siamopoulos, Kostas C.; Balafa, Olga; Slotki, Itzchak; Shavit, Linda; Stavroulopoulos, Aristeidis; Covic, Adrian; Siriopol, Dimitrie; Massy, Ziad A.; Seidowsky, Alexandre; Battaglia, Yuri; Martínez‐Castelao, Alberto; Polo-Torcal, Carolina; Coudert-Krier, Marie-Jeanne; Rossignol, Patrick; Fiaccadori, Enrico; Regolisti, Giuseppe; Hannedouche, Thierry; Bachelet, Thomas; Jager, Kitty J.; Dekker, Friedo W.; Tripepi, Rocco; Tripepi, Giovanni; Gargani, Luna; Sicari, Rosa; Picaño, Eugenio; London, Gérard M.

doi:10.1016/j.kint.2021.07.024

Cited by 51 publications

(54 citation statements)

References 16 publications

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“…Volume status was assessed by measurement of IVCD and calculation of US-B lines score through lung ultrasound; the first has been validated for estimation of intravascular volume against the objective standard method of cardiac catheterization in ESKD [43], while the second is a novel, non-invasive, validated method for assessing extravascular lung water content [44]. Moreover, according to the latest KDIGO conclusions of Controversies Conference on BP and volume management, lung ultrasound guided dry-weight probing strategies are considered promising, given favorable effects on BP levels, echocardiographic parameters, and, more recently, on reducing recurrent decompensated heart failure episodes [8,[45][46][47]. We followed a careful design, including blinded matching for a set of crucial parameters; this resulted in the absence of differences between the two dialysis groups for the majority of important variables, including age, sex, dialysis vintage, and co-morbidities.…”

Section: Discussionmentioning

confidence: 99%

Cardiac geometry, function, and remodeling patterns in patients under maintenance hemodialysis and peritoneal dialysis treatment

et al. 2021

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Cardiovascular disease is the leading cause of mortality in patients with end‐stage‐kidney disease. Evidence on the possible echocardiographic differences between hemodialysis and peritoneal dialysis (PD) is scarce. This study aimed to evaluate differences in left (LA) and right atrial (RA), left (LV) and right ventricular (RV) geometry, systolic and diastolic function in hemodialysis, and PD patients. Thirty‐eight hemodialysis and 38 PD patients were matched for age, sex, and dialysis vintage. Two‐dimensional and tissue‐Doppler echocardiography, and lung ultrasound were performed during an interdialytic day in hemodialysis and before a programmed follow‐up visit in PD patients. Vena cava diameter (11.09 ± 4.53 vs. 14.91 ± 4.30 mm; p < 0.001) was significantly lower in hemodialysis patients. Indices of LA, RA, LV, and RV dimensions were similar between the two groups. LVMi (116.91 [38.56] vs. 122.83 [52.33] g/m2; p = 0.767) was similar, but relative wall thickness was marginally (0.40 [0.14] vs. 0.45 [0.15] cm; p = 0.055) lower in hemodialysis patients. LV hypertrophy prevalence was similar between groups (73.7% vs. 71.1%; p = 0.798), but hemodialysis patients presented eccentric and PD patients concentric LVH. Regarding ventricular systolic function, stroke volume (p = 0.030) and cardiac output (p = 0.036) were higher in hemodialysis, while RV systolic pressure (RVSP) (20.37 [22.54] vs. 27.68 [14.32] mm Hg; p = 0.009) was higher in PD. No significant differences were evidenced in diastolic function indices and lung water excess between the two groups. A moderate association was noted between ultrasound B‐lines score and LA volume index (r = 0.465, p < 0.001), RVSP (r = 0.431, p < 0.001), and E/e′ ratio (r = 0.304, p = 0.009). Hemodialysis and PD patients present largely similar echocardiographic indices reflecting cardiac geometry, systolic, and diastolic function, but different patterns of abnormal LV remodeling.

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Section: Discussionmentioning

confidence: 99%

Cardiac geometry, function, and remodeling patterns in patients under maintenance hemodialysis and peritoneal dialysis treatment

et al. 2021

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“…2). The one most commonly employed is the 28-site zone [31], used in the two aforementioned validation studies of Agricola et al [23] and Enghard et al [25], as well as in most observational studies and randomized clinical trials in patients with renal diseases [10,24,[32][33][34][35][36][37], including pediatric populations Fig. 2.…”

Section: Lung Scanning Protocolsmentioning

confidence: 99%

“…The LUST study was an international, multicenter randomized controlled trial where the effect of a lung USguided treatment strategy on major outcomes (all-cause death, nonfatal myocardial infarction, and decompensated HF) was compared to standard-of-care in high-risk HD patients (history of myocardial infarction or unstable angina, acute coronary syndrome, or stable angina pectoris with documented coronary artery disease or HF with NYHA class III-IV) [37]. After a median follow-up of 1.49 years and randomization of 367 patients, no difference between the active and control arm was seen for the primary composite endpoint (all-cause death, nonfatal myocardial infarction, or decompensated HF) (HR 0.88, 95% CI: 0.63-1.24) or the secondary outcome of cardiovascular hospitalization (HR: 1.02, 95% CI: 0.71-1.46).…”

Section: Interventional Studies Using Lung Ultrasound For Assessment ...mentioning

confidence: 99%

Lung Ultrasound as a Tool to Evaluate Fluid Accumulation in Dialysis Patients

Alexandrou

Theodorakopoulou

Sarafidis³

2022

Kidney Blood Press Res

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Background: Volume overload is the main mechanism of BP elevation in end-stage kidney disease (ESKD) patients undergoing hemodialysis or peritoneal dialysis and has been linked to adverse outcomes and increased mortality in this population. Summary: This review discusses current knowledge on lung ultrasound as a tool for detection of extracellular volume overload through evaluation of extravascular lung water content. We describe the principles of lung US, the main protocols to apply it in clinical practice, and accumulated data evidence regarding its associations with cardiovascular events and mortality. We also summarize available evidence on the effect of lung-ultrasound guided volume management strategies on BP control, echocardiographic parameters and major outcomes in patients undergoing dialysis. Key Messages: Among interventions attempting to reduce the burden of cardiovascular disease in ESKD, effective management of volume overload represents an unmet clinical need. Assessment of hydration status by lung-ultrasound is a cheap, easy to employ and real-time technique that can offer accurate dry weight assessment leading to several clinical benefits.

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“…The total number of USBLs from all 28 sites gave a score that represents the severity of pulmonary congestion. Lung ultrasound tests were performed by the same experienced nephrologist who has received formal training via a remote web-based program and has been certified by an expert [8,[19][20][21]. The number of USBLs was compared in subgroups in relation to AVF patency (AVF−, AVF+, Qa < 1500 mL/min, Qa > 1500 mL/min), presence of symptoms, and history of heart disease.…”

Section: Ultrasound Assessmentmentioning

confidence: 99%

“…In a recent multicenter trial, lung ultrasound-guided hemodialysis treatment was compared with regular care. In the active arm, recurrent episodes of decompensated heart failure and cardiovascular events were reduced [8]. Lung ultrasound also has great potential as a screening and monitoring tool in SARS-CoV-2 infection.…”

Section: Introductionmentioning

confidence: 99%

Lung Congestion Severity in Kidney Transplant Recipients Is Not Affected by Arteriovenous Fistula Function

Letachowicz

Królicka

Tukiendorf

et al. 2022

JCM

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Lung ultrasound is a bedside technique for the assessment of pulmonary congestion. The study aims to assess the severity of lung congestion in kidney transplant recipients (KTR) in relation to arteriovenous fistula (AVF) patency. One hundred fifty-seven patients at least 12 months after kidney transplantation were recruited to participate in a cross-sectional study. Apart from routine visits, lung ultrasound at 28 typical points was performed. The patients were assigned to either AVF+ or AVF− groups. The mean number of lung ultrasound B-lines (USBLs) was 5.14 ± 4.96 with no differences between groups: 5.5 ± 5.0 in AVF+ and 4.8 ± 4.9 in AVF−, p = 0.35. The number and proportion of patients with no congestion (0–5 USBLs), mild congestion (6–15 USBLs), and moderate congestion (16–30 USBLs) were as follows: 101 (64.7%), 49 (31.4%), and 6 (3.8%), respectively. In multivariate analysis, only symptoms (OR 5.90; CI 2.43,14.3; p = 0.0001), body mass index (BMI) (OR 1.09; CI 1.03,1.17; p = 0.0046), and serum cholesterol level (OR 0.994; CI 0.998,1.000; p = 0.0452) contributed significantly to the severity of lung congestion. Lung ultrasound is a valuable tool for the evaluation of KTR. Functioning AVF in KTR is not the major factor affecting the severity of pulmonary congestion.

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A randomized multicenter trial on a lung ultrasound–guided treatment strategy in patients on chronic hemodialysis with high cardiovascular risk

Cited by 51 publications

References 16 publications

Cardiac geometry, function, and remodeling patterns in patients under maintenance hemodialysis and peritoneal dialysis treatment

Cardiac geometry, function, and remodeling patterns in patients under maintenance hemodialysis and peritoneal dialysis treatment

Lung Ultrasound as a Tool to Evaluate Fluid Accumulation in Dialysis Patients

Lung Congestion Severity in Kidney Transplant Recipients Is Not Affected by Arteriovenous Fistula Function

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