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

Abstract

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.

Different Interdialytic Intervals and Cardiorespiratory Fitness in Patients Undergoing Hemodialysis

“…29,30 BIS is a noninvasive method that evaluates body fluid distribution; it measures fat, lean, and cell mass and provides the estimates of total body water, extracellular and intracellular volume, and overhydration based on mathematical models. 24 Limitations include absence of standardization and influence by hypoalbuminemia, muscle wasting, and other factors. Randomized trials using BIS-based strategies to improve volume-related outcomes have largely contradictory results.…”

“…23,24 Lung ultrasound is an inexpensive and easy technique measuring excess volume in the lung surface; it is more reliable in assessing volume overload in dialysis patients than clinical judgment. 24,25 Lung ultrasound-based strategies to guide dry-weight reduction in hemodialysis were associated with reductions in 48-hour BP, 26 cardiac chamber dimensions and left ventricle filling pressures, 27 and repeated hospitalizations for heart failure. 28 BIS for the assessment of body composition was performed with the Body Composition Monitor device (Fresenius Medical Care, Bad Homburg, Germany), by applying bipolar hand and foot electrodes.…”

Lung Dysfunction and Chronic Kidney Disease: A Complex Network of Multiple Interactions

“…It should be noted that ultrasonography allows the assessment of pulmonary fluid overload at the preclinical stage and is now considered an emerging tool for monitoring fluid accumulation in HD patients [ 122 , 123 ]. However, those who routinely use chest ultrasound in HD patients must remember that B-lines are not a pathognomonic sign of watery interstitial filling, but a general sign of thickening of the interstitial septa, and that an accurate differential diagnosis with interstitial lung disease must be considered (e.g., note that fibrotic B-lines are diuresis resistant).…”

Management of intradialytic hypertension: current evidence and future perspectives

“…After nonpharmacological measures have been applied, pharmacological agents should be administrated, especially β-blockers and dihydropyridine calcium channel blockers (CCBs), depending on the patients’ condition and comorbidities, and while taking into account the pharmacological characteristics of each drug [3]. A major challenge in everyday clinical practice seems to be the attainment of ideal dry weight by carefully re-assessing and probing the patients’ dry weight or with the aid of modern technological tools, such as bioimpedance analysis or lung ultrasound [20]. This strategy is often underused resulting in inadequate BP control in many patients despite a large number of antihypertensive agents prescribed [18].…”