Kidney Week

Abstract: SA-PO352

When Is It Most Appropriate to Estimate Pulmonary Congestion Using Lung Ultrasound in Hemodialysis Patients?

Session Information

• Hemodialysis and Frequent Dialysis: CV and Risk Prediction
  November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Kaysi, Saleh, UVC Brugmann, Brussels, Belgium

Saleh Kaysi,

• Collart, Frederic, UVC Brugmann, Brussels, Belgium

Frederic Collart,

• Pacha, Bakhtar, UVC Brugmann, Brussels, Belgium

Bakhtar Pacha,

• Nortier, Joelle L., UVC Brugmann, Brussels, Belgium

Joelle L. Nortier,

Background

Lung ultrasound (LUS) helps detecting pulmonary congestion (PC) among hemodialysis (HD) patients, even when it is clinically asymptomatic. However, the best moment to measure PC in order to obtain the most useful and significant value is not clear. We conducted a longitudinal study comparing PC measured by LUS before and after the 1^st and the 2^nd HD session of the week.

Methods

Eighteen adult patients on maintenance HD for at least 6 months in our high care unit were included in this observational prospective study. Those diagnosed with interstitial lung disease or recent pneumonia, with previous lung surgery, and those with active cancer were excluded. B-lines scores were obtained by the same investigator using the 8-sites method by LUS, performed in near supine position before and after the regularly scheduled 1^st and 2^nd HD sessions of the week. The cut-off for B-lines scores was fixed to 0.54 line per zone. Total body volume using Bio-electrical Impedance Analysis (BIA) was measured before both HD sessions in each patient.

Results

Mean ultrafiltration (UF) volumes were not statistically different between both HD sessions (2,044 ± 927 vs 1,820 ± 865 mL). Mean B-lines scores pre-HD N°1 (16 ± 5.53) were quite similar to those post-HD N°1 (15.3 ± 6.63) but were statistically different before and after HD session N°2 (16.2 ± 5.26 vs 13.6 ± 5.83, P=0.03). Mean B-lines scores measured before both HD sessions were unrelated to the inter-dialytic interval (72h vs 48h) but were strongly correlated together (R²= 0.688, P<0.0001). A significant correlation was found between B-lines scores and BIA only before HD session N°2 (R²=0.372, P=0.007).

Conclusion

Our data suggest that PC, even if it decreased after HD session where UF was applied, remains quite frequent. The liquid shift from extra- to intra-vascular compartments performed at mid-week is probably more effective in reducing alveolar water to the point that might be detected as a significant lower level by LUS. Due to a shorter inter-dialysis interval, a reduced level of uremic toxins on mid-week HD session could also impact the pulmonary endothelium and capillary permeability. Consequently, we think that PC is most well correlated with dry weight when measured after the 2^nd HD session of the week.