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Abstract: TH-PO191

Lung Ultrasound for Fluid Status Assessment in Dialysis Patients: An Option to Consider

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Arias, Marta, Hospital Clínic de Barcelona, Barcelona, Spain
  • Broseta Monzo, Jose Jesus, Hospital Clínic de Barcelona, Barcelona, Spain
  • Guillen, Elena, Hospital Clínic de Barcelona, Barcelona, Spain
  • Piñeiro, Gastón Julio, Hospital Clínic de Barcelona, Barcelona, Spain
  • Rodas Marin, Lida Maria, Hospital Clínic de Barcelona, Barcelona, Spain
  • Umbert, Miquel Gomez, Hospital Clínic de Barcelona, Barcelona, Spain
  • Maduell, Francisco, Hospital Clínic de Barcelona, Barcelona, Spain
Background

Lung ultrasound (LUS) has been postulated as a possible tool to evaluate fluid status in dialysis. Objective:To verify if lung comets determination (LC), in comparison with Spectroscopic Bioimpedance-BCM and Blood volume monitoring-BVM could be a practical instrument for daily fluid status evaluation and its relationship with cardiovascular events and mortality

Methods

Two-year prospective follow-up study in 120 patients (84% hemodialysis, 16% peritoneal dialysis) 61.7±5.6 years. Two measurements were taken at the start of intermediate dialysis session: BCM to evaluate extracellular water excess(ECW%) and lung ultrasound (Philips CX50®, convex probe) to detect LC. BVM data and blood samples were also collected and an echocardiogram performed. Follow-up until death was also censored if patients moved dialysis center or received kidney transplant

Results

LC average was 3±1.3. Two groups were established according to LC number. Patients with ≥5 LC were mainly men (61.1%), younger (57.8±9.3 years), diabetic (89%), with higher CRP (1.75±1.3 mg/dL) and higher pulmonary arterial pressure (PSAP) estimated by echocardiography (37.9±2.4 mmHg) and more overhydrated by BCM(p <0.009). No differences observed in BVM. During the follow-up, 8 patients presented non-fatal cardiovascular events and 21 died. Mild pulmonary congestion (LC≥5)(p <0.028) and ECW≥20%(p <0.001) were associated with higher mortality risk (Figure 1), but not with a cardiovascular event.

Conclusion

Strengthen nephrologists’ lung ultrasound skills could be appropriate for optimizing fluid status in patients with high PSAP in those departments with US device and the right probe available, since its predictive mortality value has been demonstrated even in patients with a low LC number.