Lung Ultrasound in Hemodialysis: A Card to be Played?

Abstract

The end-stage renal disease is characterized by a profound impairment in the regulation of body fluid distribution, and volume assessment in hemodialysis is one of the challenging goals for the nephrologist. To determine a state of euvolemia, different validated techniques have been employed and among them lung ultrasonography (LUS) has recently attracted growing attention on account of its capacity to estimate accurately extra vascular lung water and to detect lung edema even in its early asymptomatic stage, that is, hidden lung congestion.With its noninvasiveness, freedom from radiation, the ease of use, acceptable intra/inter-operator reproducibility and availability of portable ultrasound devices, LUS can be considered one of the most interesting “cards to play” for the volume assessment in patients on hemodialysis.

Comparison between clinical judgment and integrated lung and inferior vena cava ultrasonography for dry weight estimation in hemodialysis patients

“…Recently, LUS has been gaining attention as a method of dry weight estimation as it accurately estimates lung congestion by measuring extravascular lung water (EVLW) . EVLW produces artifacts in LUS known as B‐lines.…”

“…The number of B‐lines reflects the amount of interstitial fluid present in the lungs. Disappearance of B‐lines immediately after a session of HD can be used to assess the adequacy of volume removal . For assessing intravascular volume status, IVC measurements using ultrasonography (USG) is a reliable noninvasive technique.…”

“…[4][5][6][7][8][9][10][11][12][13][14][15] Recently, LUS has been gaining attention as a method of dry weight estimation as it accurately estimates lung congestion by measuring extravascular lung water (EVLW). 15,16 EVLW produces artifacts in LUS known as B-lines. The number of B-lines reflects the amount of interstitial fluid present in the lungs.…”

“…Disappearance of B-lines immediately after a session of HD can be used to assess the adequacy of volume removal. 16 For assessing intravascular volume status, IVC measurements using ultrasonography (USG) is a reliable noninvasive technique. Central venous pressure (CVP) has a positive correlation with IVC size and negative correlation with IVC collapsibility index (IVCCI).…”

Lungensonografie für Anästhesie, Intensiv- und Notfallmedizin

“…Es gibt Hinweise darauf, dass die Einschätzung des interstitiellen Flüssigkeitsgehaltes mit Ultraschall bei terminaler Niereninsuffizienz Einfluss auf die Therapieentscheidung zur Hämodialyse haben kann[24][25][26]53]. Abb.…”