Abstract: SA-PO978

Utility of Lung Ultrasound B-Lines in Volume Assessment of ESRD Patients on Hemodialysis

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Saleem, Muhammad Omar, Augusta University, Medical College of Georgia, Augusta, Georgia, United States
  • Chae, Jung Hee, Augusta University, Medical College of Georgia, Augusta, Georgia, United States
  • Kabbani, Ahmad A, Augusta University, Medical College of Georgia, Augusta, Georgia, United States
  • Waller, Jennifer L., Augusta University, Medical College of Georgia, Augusta, Georgia, United States
  • White, John Jason, Augusta University, Medical College of Georgia, Augusta, Georgia, United States
  • Nahman, N. Stanley, Augusta University, Medical College of Georgia, Augusta, Georgia, United States
Background

Volume assessment in end stage renal disease (ESRD) patients on hemodialysis (HD) can be sometimes challenging. Lung ultrasound to look for B-lines, which indicate interstitial edema, is an emerging tool in assessing bedside volume status, and may assist in setting ultrafiltration (UF) goals for dialysis. We performed a quality assurance project to assess the utility of lung ultrasound in determining UF goals.

Methods

ESRD patients were studied before and after HD. Clinical parameters of volume status including systolic blood pressure (SBP) and presence of edema were recorded pre-dialysis, and target UF was set accordingly. We counted the number of B-lines pre and post HD using two portable ultrasound machines, GE V-scan and GE Sonosite. For each patient, the ultrasound probe was placed at the same mid-axillary or mid-clavicular intercostal space to visualize B-lines pre and post HD. Linear regression or ANOVA was used to examine the association between the number of B-lines and fluid removed by UF.

Results

24 ESRD patients were studied for the number of lung B-lines pre and post HD. B-lines were categorized as 0, 1-2, and 3 or more. For all patients, UF removed trended with the number of B-lines, but there was no significant association. There was a non-significant decrease in the number of B-lines with UF from 3.4±2.1 to 0.7±1.0 (p=0.53). Patients with ≥3 B-lines tended to get more volume removal with mean UF volume of 2.4±0.9L. Mean UF removal in patients with 1-2 B-lines was 1.3±0.9L, and with 0 B-lines was 1.4±0.6L. Interestingly, four patients who did not have any B-lines could not tolerate target UF set pre-HD on the basis of SBP and edema.

Conclusion

Lung ultrasound may be a useful tool for bedside volume assessment of hemodialysis patients and help in deciding UF goals to achieve dry weight. Our pilot project shows a trend that higher number of B-lines may correlate with higher UF tolerance but the data is non-significant. A larger sample size and more sophisticated portable ultrasound machines may give a better idea of any association between B-lines and the determination of UF goals in HD.