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Kidney Week

Abstract: PO1071

Can the Assessment of Ultrasound Lung Water in Hemodialysis Patients Be Simplified?

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Torino, Claudia, IFC-CNR, Reggio Calabria, Italy
  • Tripepi, Rocco, IFC-CNR, Reggio Calabria, Italy
  • Postorino, Maurizio, Nephrology Unit, GOM Reggio Calabria, Reggio Calabria, Italy
  • Tripepi, Giovanni, IFC-CNR, Reggio Calabria, Italy
  • Loutradis, Charalampos, Aristoteleio Panepistemio Thessalonikes, Thessaloniki, Central Macedonia, Greece
  • Sarafidis, Pantelis, Aristoteleio Panepistemio Thessalonikes, Thessaloniki, Central Macedonia, Greece
  • Mallamaci, Francesca, Nephrology Unit, GOM Reggio Calabria, Reggio Calabria, Italy
  • Zoccali, Carmine, IFC-CNR, Reggio Calabria, Italy

Lung Ultrasound (US) reliably estimates lung water and it is increasingly applied in clinical practice in dialysis patients. Lung water is measured by applying a semi-quantitative US score summing up the US-B lines detected in 28 lung intercostal spaces (LIS). A simplified assessment restricted to 8 LIS only has been proposed. However, the agreement among the scores has not been studied and their prognostic value has never been compared.


We included in the analysis 303 HD patients in which the pre-dialysis US-BL score was measured at baseline with both the semi-quantitative and the simplified method. The time needed for performing the 28-LIS and the 8-LIS score by six independent assessors with various experience on lung US assessment was accurately measured. Patients were divided into 4 categories, according to pre-established cut-offs specific for the two methods (28-LIS score: <5;6-15;16-30;>30 US-BL; 8-LIS score: <10;11-20;21-50;>50 US-BL). The prediction power of these scores was assessed by the explained variance (R2).


The 28-LIS score and the 8-LIS score were highly inter-related (ρ=0.93,P<0.001). During a mean follow-up of 3 years, 112 patients died and 129 experienced a CV event. At univariate and multivariate analysis, both scores were associated to the study outcomes. The R2 of the 28-LIS score for death was 4.1% and that for CV events 4.6%. The corresponding R2 of the 8-LIS score were 5.4% (death) and 4.7% (CV events), values close to those of the 28-LIS score. Accordingly, when the two scores were separately added to a clinical model including easily available clinical variables the R2 of the model including the 28-LIS score (death:31.1%; CV events:23.9%) were again very similar to those of the 8-LIS score (30.7% and 23.1%, respectively). The median time needed to perform the examination was 3:05 min (IQR 2:22–5:00 min) for the 28 LIS score and 1:35 min (IQR 1:16–2:00 min) for the 8 LIS score.


The simplified 8-LIS score is tightly related to the classical 28 LIS score and the two scores hold an almost identical predictive power. Even though the 28-LIS score demands less than 5 minutes, the 8-LIS score can be done in only about 90 sec. and it is therefore better suited for application in everyday clinical practice in hemodialysis units.