Chest ultrasound and hidden lung congestion in peritoneal dialysis patients

Panuccio, Vincenzo; Enia, Giuseppe; Tripepi, Rocco; Torino, Claudia; Garozzo, Maurizio; Battaglia, Giovanni Giorgio; Marcantoni, Carmelita; Infantone, Lorena; Giordano, Guido; Giorgi, Maria Loreta De; Lupia, M; Bruzzese, Vincenzo; Zoccali, Carmine

doi:10.1093/ndt/gfs116

Cited by 74 publications

(65 citation statements)

References 12 publications

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“…Overall, the majority of patients (59%) have an important degree of lung congestion before HD. Lung congestion in HD patients was very common also in a very recent study by Siriopol [32] and in another study in peritoneal dialysis (PD) patients [33]. In agreement with previous studies [29,31], lung congestion occurred often without clinical manifestations.…”

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

confidence: 86%

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

confidence: 86%

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

et al. 2013

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“…Ultrasound B lines are tightly associated with fundamental functional parameters of the left ventricle such as ejection fraction, left atrial volume, and pulmonary pressure (13)(14)(15); therefore, the additional explanatory power of ultrasound B lines over and above the severity of dyspnea by NYHA likely depends on the fact that pulmonary congestion by this technique captures explanatory power conveyed by low ejection fraction and other left ventricular disorders underlying water accumulation in the lungs. This study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

“…We described in detail the technique and tested its validity in hemodialysis and PD patients (14,15). The rationale of the method is that in the presence of extravascular lung water, the ultrasound beam is reflected by subpleural interlobular septa thickened by lung edema.…”

Section: Lung Ultrasonographymentioning

confidence: 99%

Asymptomatic Pulmonary Congestion and Physical Functioning in Hemodialysis Patients

Enia

Torino²,

Panuccio

et al. 2013

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Poor physical performance is common in patients with kidney failure on dialysis (CKD-5D). Whether lung congestion, a predictable consequence of cardiomyopathy and fluid overload, may contribute to the low physical performance of CKD-5D patients has not been investigated in hemodialysis patients. Design, setting, participants, & measurements This study investigated the relationship between the physical functioning scale of the Kidney Disease Quality of Life Short Form and a validated ultrasonographic measure of lung water in a multicenter survey of 270 hemodialysis patients studied between 2009 and 2010. Results Moderate to severe lung congestion by lung ultrasonography was observed in 156 (58%) patients; among these, 60 (38%) were asymptomatic (New York Heart Association [NYHA] class I). On univariate analysis, physical functioning was inversely associated with lung water in the whole group (r=−0.22; P<0.001) and in the subgroup of asymptomatic patients (r=−0.40; P=0.002). Age (r=−0.45; P<0.001) and past cardiovascular events (r=−0.22; P=0.002) were also inversely associated with physical functioning, whereas albumin (r=0.23; P<0.001) was directly associated with the same parameter. NYHA class correlated strongly with physical functioning (r=−0.52; P<0.001). In a multiple regression analysis, both NYHA class and lung water maintained an independent association with physical functioning, whereas albumin and background cardiovascular events failed to independently relate with the same outcome. Conclusions Symptomatic and asymptomatic lung congestion is associated with poor physical functioning in hemodialysis patients. This association is independent of NYHA, suggesting that this measurement and NYHA may have complementary value to explain the variability in physical performance in hemodialysis patients.

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“…Lung ultrasound (USN) has recently been reported to be useful in evaluating pulmonary edema [10,11,12]. Acoustic reverberations, identified visually as lung water ‘comets', due to pulmonary edema have been correlated with mortality, incidence of cardiac events, and hospitalization [12], and patients with severe congestion exhibited a 4.2× higher mortality and 3.2× increased risk of cardiac morbidity compared to patients without lung congestion.…”

Section: Background/aimsmentioning

confidence: 99%

Quantitative Lung Ultrasound Comet Measurement: Method and Initial Clinical Results

et al. 2015

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Background/Aims: Recently, ultrasound signals termed ‘lung water comets' associated with pulmonary edema have been correlated with adverse clinical events in dialysis patients. These comets fluctuate substantially during the ultrasound exam highlighting the need for objective quantitative measurement methods. Methods: We developed an image-processing algorithm for the detection and quantification of lung comets. Quantification measures included comet number (comet count) and the fraction of the ultrasound beams with comet findings (comet fraction). We used this algorithm in a pilot study in 20 stable dialysis outpatients to identify associations between ultrasound comets and clinical parameters including blood pressure (BP), percent blood volume reduction on dialysis (%BV), ejection fraction (EF), and ultrafiltration on dialysis (UF). Results: Positive findings included associations with lung comet measurements with pre-dialysis Diastolic BP (r = 0.534, p = 0.015), subject age (r = -0.446, p = 0.049), and a combination of EF and end dialysis %BV reduction (r = -0.585, p = 0.028). Comet fraction and comet count were closely correlated due to the inherent relationship between these two metrics (r = 0.973, p < 0.001). Negative findings included ultrasound comets that did not change from beginning to end of dialysis (p = 0.756), and were not significantly correlated with single dialysis treatment UF (p = 0.522), subject body weight (p = 0.208), or BMI (p = 0.358). Conclusions: Ultrasound signal processing methods may help quantify lung ultrasound comets. Additional findings include algorithmic lung comet measurement that did not change significantly during single dialysis sessions in these stable outpatients, but were associated with cardiovascular and fluid status parameters.

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Chest ultrasound and hidden lung congestion in peritoneal dialysis patients

Abstract: In PD patients, LW by chest US reveals moderate to severe lung congestion in a significant proportion of asymptomatic patients. Intervention studies are necessary to prove the usefulness of chest US for optimizing the control of fluid excess in PD patients.

Cited by 74 publications

References 12 publications

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

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

Asymptomatic Pulmonary Congestion and Physical Functioning in Hemodialysis Patients

Quantitative Lung Ultrasound Comet Measurement: Method and Initial Clinical Results

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