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Abstract: TH-PO249

Pulmonary Congestion Management Guided by Lung Echography in Hemodialysis: When and How?

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kaysi, Saleh, UVC Brugmann - Site Victor Horta, Laken, Bruxelles, Belgium
  • Pacha, Bakhtar, UVC Brugmann - Site Victor Horta, Laken, Bruxelles, Belgium
  • Collart, Frederic, UVC Brugmann - Site Victor Horta, Laken, Bruxelles, Belgium
  • Antoine, Marie-Helene, Universite Libre de Bruxelles, Bruxelles, Belgium
  • Nortier, Joelle L., UVC Brugmann - Site Victor Horta, Laken, Bruxelles, Belgium
Background

Assessment of pulmonary congestion (PC) by lung ultrasound (LUS) may help its management in hemodialysis (HD) patients, and better defining the dry weight (DW). We inspected the best moment to perform LUS in HD, and then applied a LUS guided DW adjustment approach.

Methods

Prospective randomized study: 18 HD patients, preceded by an observational phase: B-lines score (BLS: 8-sites method) and echocardiography were obtained before and after the first 2 HD sessions of the week. Total body volume using Bio-electrical Impedance Analysis (BIA) was measured besides serum NT-pro BNP levels. Circulating markers of inflammation (soluble urokinase Plasminogen Activator Receptor [suPAR] and soluble Suppression of Tumorigenicity 2 [sST2]) were measured. Patients were then randomized into: an active group where DW was reduced by 500 g in case of BLS > 0.54/zone measured after HD2 (every 2 weeks), and a control group where DW was modified only according to standard of care. Same measurements were repeated a month later.

Results

BLS pre-HD1 (16 ± 5.53) and post-HD1 (15.3 ± 6.63) were elevated as pre-HD2 (16.2 ± 5.26) and post-HD2 (13.6 ± 5.83). BLS was not affected by inter-dialysis interval (68h vs 44h). BIA was correlated to BLS only before HD2 (P= 0.007). BLS and the systolic cardiac function (left ventricular ejection fraction) were correlated only after HD2 ( P=0.046). NT-ProBNP levels and BLS were correlated before both sessions (P=0.004, P=0.001). Cardiac diastolic function was correlated to BLS before HD1 (P=0.002) and after HD2 (P=0.034). Mean levels (± SD, ng/ml) of suPAR (7.88 ± 3.07 and 7.78 ± 3.02) remained high (N< 4 ng/ml), while sST2 levels reached 2-fold the upper normal value (27.4 ± 17.8). At day 30, a significant reduction in BLS was obtained before (17.4 vs 8.5, P <0.0001) and after (13.3 vs 5.0, P<0.001) HD in the active group, whereas no difference was found in controls.

Conclusion

Pulmonary congestion is common in HD patients even after reaching their dry weightand is not systematically correlated to volume status or cardiac function. Chronic inflammation may be involved in PC pathophysiology. The best moment to estimate pulmonary congestion degree by lung ultrasound is after the 2nd HD session of the week, and a step by step DW adjustment guided by LUS may significantly and safely reduce PC.

Funding

  • Government Support – Non-U.S.