Abstract: FR-PO819

Use of Lung Ultrasonography to Determine the Accuracy of Clinically Estimated Dry Weight in Chronic Hemodialysis Patients

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Jiang, Chuan, Lenox Hill Hospital / Northwell Health, New York, New York, United States
  • Patel, Satyam, Lenox Hill Hospital / Northwell Health, New York, New York, United States
  • Moses, Andrew A., Lenox Hill Hospital / Northwell Health, New York, New York, United States
  • DeVita, Maria V., Lenox Hill Hospital / Northwell Health, New York, New York, United States
  • Michelis, Michael F., Lenox Hill Hospital / Northwell Health, New York, New York, United States
Background

The use of lung ultrasound (LUS) to identify extravascular lung water has received increasing acceptance. Sonographic B-lines, discrete vertical lines that originate from the pleura, represent pulmonary interstitial edema and are correlated with the accumulation of fluid. The goal of this study was to evaluate the utility of LUS to determine the accuracy of prescribed dry weight (DW) in chronic hemodialysis (HD) patients admitted to our dialysis unit and to ascertain the adequacy of fluid removal.

Methods

LUS was performed pre and post HD in 20 patients. The HD prescription and DW challenge were done independent of the results of the LUS. The presence of B-lines was tabulated and compared to the intradialytic ultrafiltration parameters.

Results

The mean age of the patients was 66.4 + 13.5 years, with 55% male, and a mean dialysis vintage of 70.2 + 8.0 months. Of the 20 patients, 3 did not exhibit B-lines at the beginning of the dialysis session. Among the other 17 patients, B-lines disappeared in 7 patients at the end of the HD session (mean B-lines 4.2 to 0). One patient was 0.3kg away from the prescribed dry weight, but the mean variance in the other 6 patients was 1.7kg below the prescribed weight. Of the remaining 10 patients, eight decreased but did not eliminate the B lines (mean B-lines 15.5 to 3.8) and were 3.8kg below DW post HD. Two patients could not reach DW or eliminate the B-lines (mean B-lines 24.5 to 10.0) and were 3.2 kg above DW post HD. Both patients exhibited more cardiac insufficiency than initially recognized. Correlation analysis showed a statistically significant correlation (P < 0.05) between the intradialytic percent change in B-lines and the percent change in total body weight (r =0.40) and ultrafiltration rate (r = 0.33). Seven of 10 patients with clear chest x-rays pre HD exhibited B-lines.

Conclusion

This study supports the hypothesis that reduction of B-lines during HD can provide accurate information regarding changes in pulmonary fluid content. Further, LUS is an invaluable diagnostic tool for recognizing both the adequacy of fluid removal and the occurrence of error in the estimation of dry weight by usual clinical parameters.