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Abstract: TH-PO192

Lung Ultrasound: A New Technique for Fluid Status Assessment in an Asian Haemodialysis Cohort

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Chua, Yan Ting, National University Hospital, Singapore, Singapore, Singapore
  • Wong, Weng Kin, National University Hospital, Singapore, Singapore, Singapore
  • Ngoh, Clara Lee Ying, National University Hospital, Singapore, Singapore, Singapore
Background

Studies in non-Asian haemodialysis (HD) cohorts have shown that lung congestion is an insidious problem with negative impact on cardiovascular outcomes. However, assessment of extravascular lung water (EVLW) clinically is difficult. Markers such as plasma N-terminal pro-B-type natriuretic peptide (NT-pro BNP) and bioimpedance analysis (BIA) have uncertain correlations with EVLW. In recent years, point-of-care lung ultrasound (POCLUS) has emerged as a new technique to assess EVLW. However, there is a dearth of Asian studies. We compared the performance of a 28-point POCLUS protocol against clinical examination, NT-pro BNP and BIA in an Asian HD cohort.

Methods

We performed a prospective observational study of 20 HD patients undergoing dialysis at our institution. Patients were assessed pre- and post-HD using a 28-point POCLUS protocol, with physical examination for lung crepitations and pedal oedema, and with plasma NT-pro BNP and BIA. BIA was performed using the Bodystat Quadscan 4000 (BQ4000). Patients with active cardiac disease (angina and recent myocardial infarction in last 6 months), lung pathology (infection, interstitial lung disease or malignancy), cardiac devices and limb amputations were excluded.

Results

Pre-HD, 18 (90%) of the patients had moderate fluid overload, defined as ≥15 B-lines. However, 4 (22%) of this cohort had neither lung crepitations nor pedal oedema detected clinically. Pre-HD B-line score was positively correlated with pre-HD NT-pro BNP (rho=0.654, p=0.006), but not with pre-HD positive hydration status by BIA (p=0.051). B-line score significantly decreased post-HD (pre-HD 51.7 ± 32.5 to post-HD 24.9 ± 26.4, p<0.001). Reduction in B-lines from pre- to post-HD was associated with a corresponding reduction in NT-pro BNP (rho = 0.994, p<0.001). Post-HD, 2 out of 7 of patients who achieved weights within 0.5kg of dry weight still had ≥15 B-lines on POCLUS. Both patients did not manifest lung crepitations or pedal oedema post-HD.

Conclusion

In this cohort of patients, POCLUS showed good correlation with NT-pro BNP, but not with BIA. It also demonstrated significant promise in recognising asymptomatic pulmonary congestion. Further longitudinal studies are required to investigate for potential benefits of POCLUS in volume management of HD patients.