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Abstract: TH-PO251

Volume Status Assessed by Physical Examination Correlates with Lung Ultrasound Findings in Patients with CKD

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kliuk Ben Bassat, Orit, Tel Aviv Sourasky Medical Center, Tel Aviv, Tel Aviv, Israel
  • Raz, Michal Ariela, Tel Aviv Sourasky Medical Center, Tel Aviv, Tel Aviv, Israel
  • Grupper, Ayelet, Tel Aviv Sourasky Medical Center, Tel Aviv, Tel Aviv, Israel
Background

Volume overload is common in patients with chronic kidney disease (CKD), predominantly in dialysis patients. Volume assessment by physical examination (PE) may be subjective, therefore more accurate methods are necessary. Lung ultrasound (LUS) is one method used to accurately diagnose dry weight in dialysis patients. We aimed to assess LUS accuracy compared to PE in the range of CKD stages.

Methods

A prospective single center study. Hemodialysis (HD), peritoneal dialysis (PD) and CKD 1-5 patients were enrolled. PE was performed prior to LUS to evaluate signs of volume overload. Lung findings (crackles, pleural effusion) were reported as present or not, peripheral edema was graded 0-41. HD patients were examined twice, pre and post dialysis. LUS was performed by inspection of 12-zones. Each zone was assigned 0 points for less than 2 separated B-lines, 1 point if more than 3 B-lines were observed, 2 points when multiple B-lines with coalescing lines were documented and 3 points in cases of pulmonary consolidation. Accordingly, exam scores could range from 0, indicating a normal exam, to 36, indicating worst congestion possible. Results of PE and LUS were compared.

Results

Among 175 participants, 112 were HD patients, 18 PD and 45 CKD 1-5ND patients. Higher LUS scores correlated with presence of lung crackles (OR=1.16 (1.10-1.23) p<0.01) and pleural effusion (OR=1.17 (1.11-1.23) p<0.01). There was a significant correlation between LUS score and peripheral edema (Figure 1), and an inverse correlation between room air saturation and LUS score (r=-0.143, p=0.017). In HD patients weight differences before and after dialysis (delta weight) were compared with LUS score difference before and after dialysis (delta score). There was a linear correlation between delta weight and delta score (r=0.225, p=0.013).

Conclusion

LUS correlates significantly with PE findings in volume overload assessment in a broad spectrum of CKD patients.

(r=0.27, p<0.001)

Funding

  • Private Foundation Support