Abstract: FR-PO820

Use of Lung Ultrasonography for Assessment and Follow Up of Asymptomatic Pulmonary Congestion in Hemodialysis Patients

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Author

  • Naga, Salah S., Alexandria Faculty of Medicine, Alexandria, Alexandria, Egypt
Background

Chronic fluid overload is a common problem in ESRD patients on HD. Even asymptomatic lung congestion results in increased cardiovascular morbidity and mortality. Lung ultrasound provides a non-invasive tool to assess fluid overload. The aim of the study was to assess asymptomatic pulmonary congestion using lung ultrasonography and to evaluate the effect of increasing hemodialysis dose on improvement of the lung comet scores.

Methods

One hundred patients were enrolled. Based on ultrasound lung comets (ULC) score, patients were divided into group A (65 patients) with no or mild pulmonary congestion (ULC<14) and group B (35 patients) with moderate to severe (ULC>14). Group B was further subdivided into group B1 (18 patients) who were subjected to intensified HD and group B2 (17 patients) who were maintained on their conventional HD, and both subgroups were followed for three months.

Results

Baseline ULC score showed a significant positive correlation with LAP (r=0.808, p <0.001), LAD (r=0.519, p<0.001), IVCD (r=0.669, p<0.001), SBP (r=0.578, p<0.001) and DBP (r=0.435, p<001) and a strong negative correlation with EF (r=0.542, p<0.001) and inferior vena cava collapsibility index (IVCCI) (r=0.571, p<0.001). After intensified HD, Group B1 showed a significant decrease in the ULC score (25.44±6.13 to 9.17 ± 3.65, p<0.001), left atrial pressure (LAP) (16.22 ± 1.72 to 12.16 ±1.90, p<0.001), left atrial diameter (LAD) (41.33 ± 4.06 to 39.53 ± 2.73, p=0.003), inferior vena cava diameter (IVCD) (12 .65 ± 1.74 to 9.86 ± 1.61, p<0.001), SBP (146.67 ± 17.15 to 130.0 ± 12.83, p<0.001) and DBP (87.22 ± 6.96 to 82.22 ± 4.28, p=0.001) in comparison to group B2.

Conclusion

The present study demonstarted that lung ultrasonography guided intensified HD dose improved patients lung comets score, LAP, LAD, IVCD, IVCCI and blood pressure. ULC monitoring is an easy tool to detect asymptomatic lung congestion and allows tailoring dialysis to treat it.