Intradialytic Hypotension in Critically Ill Patients on Hemodialysis With A-Line versus B-Line Pattern on Lung Ultrasonography

Khanin, Yuriy; Hirsch, Jamie S.; Stalbow, Daniel; Zhang, Meng; Hasan, Zubair; Ross, Daniel W.

doi:10.1016/j.ekir.2021.04.010

Cited by 8 publications

(7 citation statements)

References 6 publications

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“…A similar study showed that there was an increased risk of IDH in critically ill patients on intermittent HD with <14 pre-dialysis B-lines only if they presented a concomitant vena cava collapsibility ≤ 11.5 mm m −2 [ 38 ]. Another study, again on patients undergoing HD in an intensive care setting, showed that patients with documentation of an A-line pattern (indicating a dry lung) had a higher incidence of IDH than those with an overriding B-line pattern, although the authors did not provide a prognostic threshold in the B-line score [ 39 ]. In our study, a significantly lower number of B-lines post-dialysis was identified in patients who experienced IDH, with ≤5 B-lines in most patients, highlighting the central role of hypovolemia in IDH etiopathogenesis.…”

Section: Discussionmentioning

confidence: 99%

Pre-Dialysis B-Line Quantification at Lung Ultrasound Is a Useful Method for Evaluating the Dry Weight and Predicting the Risk of Intradialytic Hypotension

et al. 2022

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Intradialytic hypotension (IDH) is a frequent and well-known complication of hemodialysis, occurring in about one third of patients. An integrated approach with different methods is needed to minimize IDH episodes and their complications. In this prospective observational study, recruited patients underwent a multiparametric evaluation of fluid status through a lung ultrasound (LUS) with the quantification of B-lines, a physical examination, blood pressure, NT-proBNP and chest X-rays. The evaluation took place immediately before and at the end of the dialysis session, and the patients were divided into IDH and no-IDH groups. We recruited a total of 107 patients. A pre-dialysis B-line number ≥ 15 showed a high sensitivity in fluid overload diagnosis (94.5%), even higher than a chest X-ray (78%) or physical examination (72%) alone. The identification at the beginning of dialysis of <8 B-lines in the overall cohort or <20 B-lines in patients with NYHA 3–4 class are optimal thresholds for identifying those patients at higher risk of experiencing an IDH episode. In the multivariable analysis, the NYHA class, a low pre-dialysis systolic BP and a low pre-dialysis B-line number were independent risk factors for IDH. At the beginning of dialysis, the B-line quantification at LUS is a valuable and reliable method for evaluating fluid status and predicting IDH episodes. A post-dialysis B-line number <5 may allow for an understanding of whether the IDH episode was caused by dehydration, probably due to due to an overestimation of the dry weight.

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Section: Discussionmentioning

confidence: 99%

Pre-Dialysis B-Line Quantification at Lung Ultrasound Is a Useful Method for Evaluating the Dry Weight and Predicting the Risk of Intradialytic Hypotension

et al. 2022

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“…48 They found that patients with documentation of an A-line pattern (indicating a dry lung) had a higher incidence of intradialytic hypotension than those with an overriding B-line pattern (indicating a wet lung) with odds ratio 3.63 (95% CI 1.40 -9.40) and odds ratio 3.01 (95% CI 1.10 -8.22) after adjustment for APACHE score. 48 These studies suggest that clinical ultrasound may be helpful in identifying patients tolerant of volume removal.…”

Section: Interventional Studiesmentioning

confidence: 97%

“…In contrast, patients without pulmonary congestion and IVC distention had the highest incidence of IDH, although, in general, patients with IVC distention had less IDH, irrespective of the presence or absence of pulmonary congestion. Following up on this result, Khanin and colleagues (47) conducted a retrospective analysis in an intensive care setting of 113 patients undergoing HD with lung ultrasound pattern documented by the treating team on the same day. They found that patients with documentation of an A-line pattern (indicating a dry lung) had a higher incidence of IDH than those with an overriding B-line pattern (indicating a wet lung), with an odds ratio of 3.63 (95% CI, 1.40 to 9.40) and odds ratio of 3.01 (95% CI, 1.10 to 8.22) after adjustment for the Acute Physiology and Chronic Health Evaluation (APACHE II) score (47).…”

Section: Prediction Of Idhmentioning

confidence: 99%

“…Following up on this result, Khanin and colleagues (47) conducted a retrospective analysis in an intensive care setting of 113 patients undergoing HD with lung ultrasound pattern documented by the treating team on the same day. They found that patients with documentation of an A-line pattern (indicating a dry lung) had a higher incidence of IDH than those with an overriding B-line pattern (indicating a wet lung), with an odds ratio of 3.63 (95% CI, 1.40 to 9.40) and odds ratio of 3.01 (95% CI, 1.10 to 8.22) after adjustment for the Acute Physiology and Chronic Health Evaluation (APACHE II) score (47). These studies suggest that clinical ultrasound may be helpful in identifying patients tolerant of volume removal.…”

Section: Prediction Of Idhmentioning

confidence: 99%

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Quantitative Lung Ultrasonography for the Nephrologist: Applications in Dialysis and Heart Failure

Reisinger

Koratala

2022

Kidney360

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Volume overload and its attendant increase in acute care utilization and cardiovascular morbidity and mortality represents a critical challenge for the practicing nephrologist. This is particularly true among patients with ESKD on HD where pre-dialysis volume overload and intradialytic and postdialytic hypovolemia account for almost a third of all cost for the Medicare dialysis benefit. Quantitative lung ultrasound is a tool for assessing the extent of extravascular lung water which outperforms physical exam and plain chest radiography. B-lines are vertical hyperechoic artifacts present in patients with increased extravascular lung water. B-lines have been shown to decrease dynamically during the hemodialysis treatment in proportion to ultrafiltration volume. Among patients with chronic heart failure, titration of diuretics based on the extent of pulmonary congestion noted on lung ultrasonography has been shown to decrease recurrent acute care utilization. Early data from randomized-controlled trials of lung ultrasound-guided ultrafiltration therapy among patients with ESKD on HD have shown promise for potential reduction in recurrent episodes of decompensated heart failure and cardiovascular events. Ultimately lung ultrasound may predict those who are ultrafiltration tolerant and could be used to decreased acute care utilization and thus cost in this population.

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“…The assessment of patients' volume status by clinicians is often based on the clinical features of patients, such as vital signs, peripheral edema signs, jugular vein dilatation, pulmonary auscultation and so on. In recent years, with the development of clinical research and technology, some new tools to objectively evaluate the fluid status of patients have been increasingly used by clinicians, including bioimpedance spectrum [1], lung ultrasound [2,3] , inferior vena cava ultrasound, echocardiography and other devices. These modern technologies and analytical tools help clinicians adjust ultrafiltration and dialysis prescriptions in a more precise and personalized manner to ensure that patients get the best volume condition, thus helping to minimize the risk of IDH.…”

Section: Setting An Appropriate Dry Weightmentioning

confidence: 99%

Personalized prevention and treatment strategies for hypotension patients during maintenance hemodialysis

2023

MEDSC

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Hemodialysis (HD) is the most common renal replacement therapy for patients with end-stage renal disease. Intradialytic hypotension (IDH) is a serious complication during dialysis. It is mainly related to hypovolemia, resulting in premature interruption of dialysis, and insufficient clearance of fluid and solute, which eventually causes a variety of adverse clinical outcomes such as decline in quality of life, inadequate dialysis, vascular access embolism, loss of residual renal function, cardiovascular events and death, seriously threatening the life and health of patients. Despite its clinical significance, the early prediction of IDH remains a challenge. In recent years, the discovery of some new biomarkers and the use of volume assessment devices, hemodialysis equipment, biofeedback systems, new drugs and artificial intelligence early warning models have provided great help in the early identification and treatment of IDH. In view of the clinical heterogeneity of blood pressure changes in hemodialysis patients, it has become an inevitable trend to shift from standardized management to personalized nursing. This article mainly reviews the best strategies for personalized prevention and treatment of IDH.

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Intradialytic Hypotension in Critically Ill Patients on Hemodialysis With A-Line versus B-Line Pattern on Lung Ultrasonography

Cited by 8 publications

References 6 publications

Pre-Dialysis B-Line Quantification at Lung Ultrasound Is a Useful Method for Evaluating the Dry Weight and Predicting the Risk of Intradialytic Hypotension

Pre-Dialysis B-Line Quantification at Lung Ultrasound Is a Useful Method for Evaluating the Dry Weight and Predicting the Risk of Intradialytic Hypotension

Quantitative Lung Ultrasonography for the Nephrologist: Applications in Dialysis and Heart Failure

Personalized prevention and treatment strategies for hypotension patients during maintenance hemodialysis

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