Comparison between lung ultrasonography and current methods for volume assessment in Asian chronic hemodialysis patients

Abstract

Introduction: Volume assessment in end-stage kidney disease patients on hemodialysis (HD) remains inadequate by existing methods: clinical examination, bioimpedance spectroscopy, measurement of inferior vena cava diameter by ultrasound (IVCD), and plasma B-type natriuretic peptide (NT-pro BNP). This study aims to compare the performance of lung ultrasound against existing methods for volume assessment in a HD cohort. Methods: Two nephrologists independently performed 28-point lung ultrasound immediately before and after midweek HD in 50 patients. Lung congestion was classified into mild, moderate, and severe categories based on lung ultrasound findings. Clinical examination for crepitations and oedema, change in hydration status (ΔHS) measured by bioimpedance spectroscopy, NT-pro BNP, IVCD during inspiration (IVCDimin), expiration (IVCDimax), and inferior vena cava collapsibility index were also assessed before and after midweek HD. Findings: In all, 61% of patients with normohydration status by bioimpedance spectroscopy had moderate or severe lung congestion on lung ultrasound. There were significant correlations between predialysis lung ultrasound, and NT-pro BNP (r = 0.432, P = 0.004), ΔHS (r = 0.447, P < 0.001), and IVCD parameters (P < 0.05). Some correlations weakened postdialysis (ΔHS [r = 0.322, P = 0.01] and IVCDimax [r = 0.307, P = 0.03]), whereas NT-pro BNP and ΔHS paradoxically increased in 28% and 30% of the cohort, respectively. On receiver operator curve analysis, most methods of volume assessment had limited discriminatory power to detect mild lung congestion. Discussion: Lung ultrasound demonstrates some comparability with existing volume assessment methods in Asian dialysis patients. However, it appears more effective at detecting subclinical pulmonary congestion, and tracking fluid changes real-time compared to bioimpedance spectroscopy and NT-pro BNP.

Lung ultrasound as an evolving tool in the detection of extravascular lung water following goal-directed fluid therapy in septic cancer patients

“…In a recent study investigating the role of B-lines in the assessment of volume variation in hemodialysis patients, there was a moderate negative correlation with the IVC CI index. 26 Analysis of the ROC curve in the present study showed a good to an excellent performance of LUS in predicting lung congestion. The performance of B-lines as predictors for lung congestion was assessed by some previous studies in patients with several clinical conditions.…”

Lung Ultrasound Estimates the Overhydration and Benefits Blood Pressure Control in Normal or Mild Symptomatic Hemodialysis Patients

“…33 Previous studies have compared several methods for dry weight guidance in HD patients which demonstrated the promise of the LUS-guided technique as an increase of TLUSS correlated with interdialytic weight gains, and a reduction of B-lines possibly related with lost volumes during HD including inferior vena cava diameters and atrial dimensions. 15,21,25,31,[34][35][36] Torino et el, evaluated the fluid accumulation by using physical examination, ie, standardized lung auscultation and quantification of peripheral edema compared with LUS which found that lung crackles, either alone or in combination with peripheral edema, poorly reflected the interstitial lung edema in HD patients and these findings support using add-on LUS to evaluate fluid accumulation and lung congestion. 12 This study supported an insensitivity of the clinical signs and a value of LUS-guided treatment by achievement of target weight by reduction of prescribed dry weight if moderate pulmonary congestion was presented (TLUSS ≥16) resulting in controllable pre-HD, SBP, MAP and reduction of heart size and NT-proBNP levels.…”

Dynamic changes and prognosis of pulmonary congestion by lung ultrasound in hemodialysis patients: a systematic review and meta-analysis

“…Noble et al in a quantitative analysis of a small sample of patients found that for every 500 ml ultrafiltration, the number of B-lines decreased by about 2.7 [18]. Ngoh et al found that despite the elimination of body fluids, the NT-pro BNP and bioimpedance spectrum index increased inexplicably after dialysis [19]. This means that the current capacity evaluation methods have a reduced ability to detect changes of liquid state after hemodialysis.…”

“…Changes in the B-line dialysis process were correlated with ultrafiltration volume and weight loss [6,[8][9][10]. Furthermore, the B-line level were significantly correlated with other capacity evaluation indicators (e.g., the bioimpedance spectroscopy indicators, inferior vena cava diameter and NT-proBNP) [5,11,19].…”