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Kidney Week

Abstract: PO1234

Role of Lung Ultrasonography to Predict Intradialytic Hypotension in ICU Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Khanin, Yuriy, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Stalbow, Daniel, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Hirsch, Jamie S., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Ross, Daniel W., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Background

Lung ultrasonography has emerged as a valuable tool in the assessment of volume status in hemodialysis (HD) patients. A-line profile noted on lung ultrasonography denotes low wedge pressure while B-line profile is associated with hypervolemia. We hypothesized that patients with A-line profile are more likely to experience intradialytic hypotension (IDH).

Methods

We identified all patients admitted to the Medical ICU at two tertiary care facilities in the Northwell Health system between Jan 1st, 2016 and Sep 23rd, 2019 in whom hemodialysis was performed and a lung ultrasound was documented the same day. We manually reviewed clinician documentation and included patients whose lung ultrasound findings demonstrated A-line profile or B-line profile. Patients with other lung ultrasound findings were excluded. IDH was defined as a decrease in systolic BP by ≥20 mmHg with a failure to meet UF goal or increase in pressor requirement during HD or associated symptoms of hypotension. In total 105 dialysis treatments were reviewed, 78 were included for analysis. Northwell IRB exempted the study for full IRB review.

Results

There were 55 treatments with A-line profile and 23 treatments with B-line profile on POCUS. The incidence of IDH in a HD treatment with A-line and B-line profile was 50.9% and 21.7% respectively. 13 HD treatments with A-line profile and 1 with B-line profile had an increase in pressor requirement.

Conclusion

Lung ultrasonography provides a quick and effective means of assessing volume status. Our data suggest that IDH occurs more frequently in patients with A-line profile compared to those with B-line profile. Further research should focus on describing the relationship between lung ultrasound and IDH.

Lung US FindingNumber of treatmentsIntradialytic Hypotension (%)Mean Pre-HD Blood PressureMean Dialysate Temperature (C)Na Modeling (%)
A-Line Profile5550.9133/6736.37.3
B-Line Profile2321.7142/6836.413