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Abstract: FR-PO277

Comparison of Indicators of Fluid Overload in Hemodialysis Patients

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Yarmey, Erik, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Mazumder, Proma, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Brown, Jordan, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Shofer, Frances, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Dean, Anthony J., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Panebianco, Nova, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Reisinger, Nathaniel C., University of Pennsylvania, Philadelphia, Pennsylvania, United States
Background

Fluid overload (FO) contibutes to mortality in hemodialysis (HD) patients and is often undiagnosed. FO is determined by physical exam including systolic and diastolic blood pressure (SBP, DBP), lung crackles (rales), lower extremity edema (LEE), and jugular venous distention (JVD). Other signs of FO include serum n-terminal pro-BNP (BNP) and findings on chest x-ray (CXR) or thoracic computed tomography (CT). Point-of-care ultrasound is a as powerful tool for determination of FO via measurements of the inferior vena cava (IVC) and quantitative 28-point lung ultrasonography for B-line score (BLS). We present a cohort study of HD patients comparing indicators of FO.

Methods

Patients with ESRD on HD were enrolled from a large urban emergency department at a referral center. Patients were excluded if they were unable to consent. Indicators of FO were obtained prior to first HD including BLS (0-280). IVC size and collapse was graded by 2 independent observers on a 4-point scale. 10 indicators of FO (BLS, IVC, CXR, CT, BNP, rales, LEE, JVD, SBP, DBP) were compared against presence or absence of FO as determined by the treating nephrologist or on chart review.

Results

Of 101 patients enrolled, median age was 60, 51% were male, 84% identified as Black or African American. Comorbidities included 65% diabetic, 27% coronary artery disease, 33% airways disease, 40% had systolic heart failure, 75% diastolic heart failure. Median dialysis vintage was 33 months. Access type was 54% arteriovenous fistula, 29% graft, and 17% catheter. ESRD vintage was 33 months. Residual renal function was minimal. 62% of patients had FO on arrival and 27% of visits were for FO. BLS was available for 101 patients with median score of 34. Area under the receiver-operator characteristic curve (AUC) was 0.95 for BLS [95% CI 0.92-0.99] with optimal cutoff of 30. AUC was 0.60 for edema [0.53-0.68], 0.60 for rales [0.54-0.66], 0.53 for JVD [0.50-0.56], 0.53 for SBP [0.41-0.65], 0.49 for DBP [0.38-0.61]. IVC was obtained on 37 patients AUC 0.78 [0.61-0.95]. BNP was obtained on 39 patients AUC 0.80 [0.63-0.98]. CXR was obtained on 76 patients AUC 0.71 [0.61-0.80]. CT was available on 20 patients AUC 0.91 [0.81-1.00].

Conclusion

Quantitative BLS outperforms conventional physical exam, serologic, and other imaging indicators in determination of FO in HD patients.