Asymptomatic Pulmonary Congestion and Physical Functioning in Hemodialysis Patients

Enia, Giuseppe; Torino, Claudia; Panuccio, Vincenzo; Tripepi, Rocco; Postorino, Maurizio; Aliotta, Roberta; Bellantoni, Marianna; Tripepi, Giovanni; Mallamaci, Francesca; Zoccali, Carmine

doi:10.2215/cjn.11111012

Cited by 52 publications

(45 citation statements)

References 18 publications

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“…That may be the reason of the relationship between B-lines and body weight. Giuseppe et al previously reported that physical functioning was inversely associated with the number of Blines and patient age and was positively associated with the serum albumin level [40]. In our study, patient age tended to be positively associate with the number of B-lines (P = 0.055).…”

Section: Discussionsupporting

confidence: 60%

Association between B-lines detected during lung ultrasound and various factors in hemodialysis patients

et al. 2017

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Background: In recent years, the use of chest ultrasonography to detect lung water has received growing attention in clinical research. Estimation of the number of B-lines using lung ultrasound is now a standard method for the evaluation of pulmonary congestion. In the present study, we examined the relation between the number of B-lines and clinical parameters in hemodialysis patients. Methods: A total of 49 consecutive patients receiving maintenance hemodialysis were enrolled in this study. Lung ultrasound was performed using Vscan® (GE Healthcare, Japan). Bilateral scanning of the anterior and lateral chest walls was performed with the patient in a supine position just after the start of the hemodialysis therapy. The total number of B-lines was estimated. We investigated the relationships between the number of B-lines and other clinical parameters. Results: Patient heart rate and the serum log [NT-proBNP] level were positively correlated (P = 0.009 and 0.003, respectively), and body weight and the serum albumin and creatinine level were negatively correlated with the number of B-lines (P = 0.023, 0.001, and 0.011, respectively). Conclusions: The number of B-lines was positively correlated with the serum N-terminal pro-brain natriuretic peptide level. Lung ultrasound can quantify lung edema. Body weight and the serum albumin and creatinine level were negatively correlated with the number of B-lines. Careful attention to the presence of pulmonary edema is needed in patients with a low body weight and a low serum albumin and creatinine level.

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Section: Discussionsupporting

confidence: 60%

Association between B-lines detected during lung ultrasound and various factors in hemodialysis patients

et al. 2017

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“…In agreement with previous studies [29,31], lung congestion occurred often without clinical manifestations. However, in both HD [34] and PD patients [35], lung congestion is not an innocent bystander which is strongly and independently associated with poor physical performance measured by the physical dimension item of the Short-Form 36 Quality Of Life Instrument. In the two studies where US lung water was measured along with total body water by bioimpedance analysis [29,32], these two parameters were very weakly associated, which indicates that lung congestion can only partly be explained by volume overload.…”

Section: Lung Congestion In Dialysis Patients: Risk Factors and The Pmentioning

confidence: 99%

Lung Congestion as a Risk Factor in End-Stage Renal Disease

et al. 2013

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Background: Lung congestion is emerging as a pervasive, insidious problem in end-stage renal disease (ESRD) patients on dialysis. Summary: Chest ultrasound (US), a novel, easy-to-perform, cheap technique, which is currently applied for objective monitoring of pulmonary congestion in patients with heart failure in Europe, allows reliable quantification of lung water in clinical practice. Before hemodialysis (HD), about 60% of ESRD patients displayed moderate-severe lung congestion and this alteration is frequently asymptomatic. Lung congestion is reduced but not abolished by ultrafiltration dialysis, and about one third to one fourth of patients still have excessive lung water after dialysis. Lung congestion is also prevalent in patients on peritoneal dialysis (PD), and in apparently asymptomatic HD and PD patients this alteration is strongly associated with poor physical performance. Lung water in HD patients correlates in an inverse fashion with echocardiographic parameters of systolic and diastolic function, but it is only weakly related with hydration status measured by bioimpedance analysis. Moderate-severe lung congestion is a strong predictor of death and cardiovascular events and provides prognostic information independent of NYHA class, and traditional and nontraditional risk factors in ESRD patients on HD. Key Messages: Systematic application of chest US in ESRD patients shows that hidden or clinically manifest lung congestion is exceedingly frequent in this population. This alteration largely reflects left ventricular disorders superimposed on volume overload. The clinical usefulness of systematic application of chest US in ESRD remains to be tested in a formal clinical trial.

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“…Severe pulmonary congestion was also described in few asymptomatic patients. This subtle lung congestion state was found in different studies to correlate with physical performance in ESRD patients on HD, independent of their NYHA score [20]. …”

Section: Discussionmentioning

confidence: 99%

“…It surpasses the overall hydration status, inflammation (assessed by C-reactive protein), and cardiac parameters in predicting the risk of death and cardiac events. The BLUS score, which correlated with the body water content, has become a strong, independent predictor of death and cardiac events in this population [2,3,14,21,22]. …”

Section: Discussionmentioning

confidence: 99%

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Relevance of B-Lines on Lung Ultrasound in Volume Overload and Pulmonary Congestion: Clinical Correlations and Outcomes in Patients on Hemodialysis

Saad

Kamal

Moussaly³

et al. 2017

Cardiorenal Med

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Background: Volume overload in patients on hemodialysis (HD) is an independent risk factor for cardiovascular mortality. B-lines detected on lung ultrasound (BLUS) assess extravascular lung water. This raises interest in its utility for assessing volume status and cardiovascular outcomes. Methods: End-stage renal disease patients on HD at the Island Rehab Center being older than 18 years were screened. Patients achieving their dry weight (DW) had a lung ultrasound in a supine position. Scores were classified as mild (0-14), moderate (15-30), and severe (>30) for pulmonary congestion. Patients with more than 60 were further classified as very severe. Patients were followed for cardiac events and death. Results: 81 patients were recruited. 58 were males, with a mean age of 59.7 years. 44 had New York Heart Association (NYHA) class 1, 24 had class 2, and 13 had class 3. In univariate analysis, NYHA class was associated with B-line classes (<0.001) and diastolic dysfunction (0.002). In multivariate analysis, NYHA grade strongly correlated with B-line classification (0.01) but not with heart function (0.95). 71 subjects were followed for a mean duration of 1.19 years. 9 patients died and 20 had an incident cardiac event. A Kaplan-Meier survival analysis demonstrated an interval decrease in survival times in all-cause mortality and cardiac events with increased BLUS scores (p = 0.0049). Multivariate Cox regression analysis showed the independent predictive value of BLUS class for mortality and cardiac events with a heart rate of 2.98 and 7.98 in severe and very severe classes, respectively, compared to patients in the mild class (p = 0.025 and 0.013). Conclusion: At DW, BLUS is an independent risk factor for death and cardiovascular events in patients on HD.

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Asymptomatic Pulmonary Congestion and Physical Functioning in Hemodialysis Patients

Cited by 52 publications

References 18 publications

Association between B-lines detected during lung ultrasound and various factors in hemodialysis patients

Association between B-lines detected during lung ultrasound and various factors in hemodialysis patients

Lung Congestion as a Risk Factor in End-Stage Renal Disease

Relevance of B-Lines on Lung Ultrasound in Volume Overload and Pulmonary Congestion: Clinical Correlations and Outcomes in Patients on Hemodialysis

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