A nephrology trainee can define the fluid status through lung ultrasonography and inferior vena cava measurements in hemodialysis patients: an observational study in a single center.
Hemodialysis
Hydric status
Ideal weight
Inferior vena cava
Lung ultrasound
Journal
Journal of ultrasound
ISSN: 1876-7931
Titre abrégé: J Ultrasound
Pays: Italy
ID NLM: 101315005
Informations de publication
Date de publication:
12 Jun 2024
12 Jun 2024
Historique:
received:
14
12
2023
accepted:
09
04
2024
medline:
13
6
2024
pubmed:
13
6
2024
entrez:
12
6
2024
Statut:
aheadofprint
Résumé
The determination of ideal weight in hemodialysis patients remains a common problem. The use of Lung Ultrasound (LUS) is an emerging method of assessing the hydric status of hemodialysis patients. LUS combined with Inferior Vena Cava (IVC) ultrasonography can define the fluid status in hemodialysis patients. This study included 68 hemodialysis patients from the Dialysis Unit of Papageorgiou General Hospital in Thessaloniki. The patients underwent lung and IVC ultrasound 30 min before and after the end of the dialysis session by a nephrology trainee. Patients' ideal weight was modified based on daily clinical practice rather than ultrasound findings. The presence of B lines and ultrasound findings of the IVC were evaluated. The average B line score was 11.53 ± 5.02 before dialysis and became 5.57 ± 3.14 after the session. The average diameter of the IVC was 14.266 ± 0.846 mm before dialysis and 12.328 ± 0.879 mm after the session. The patients were categorized based on the magnitude of overhydration and the findings were evaluated. In addition, findings after the session showed a statistically significant correlation between the b line score and the diameter of the IVC adjusted for the body surface area. (p = 0.009 < 0.05). A high rate of hyperhydration was detected before the dialysis session (25%). While it is the first study conducted by a nephrology trainee highlighting that it is a feasible technique. Intervention studies should be carried out in the future to draw more precise conclusions.
Identifiants
pubmed: 38867096
doi: 10.1007/s40477-024-00903-x
pii: 10.1007/s40477-024-00903-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).
Références
Thomson GE, Waterhouse K, McDonald HP, Friedman EA (1967) Hemodialysis for chronic renal failure. Clinical observations. Arch Intern Med 120(2):153–167
doi: 10.1001/archinte.1967.00300020025002
pubmed: 4952668
Agarwal R, Weir MR (2010) Dry-weight: a concept revisited in an effort to avoid medication-directed approaches for blood pressure control in hemodialysis patients. Clin J Am Soc Nephrol 5(7):1255–1260. https://doi.org/10.2215/CJN.01760210
doi: 10.2215/CJN.01760210
pubmed: 20507951
pmcid: 2893058
Charra B et al (1996) Clinical assessment of dry weight. Nephrol Dial Transplant 11(Suppl 2):16–19. https://doi.org/10.1093/ndt/11.supp2.16
doi: 10.1093/ndt/11.supp2.16
pubmed: 8803988
Sinha AD, Agarwal R (2009) Can chronic volume overload be recognized and prevented in hemodialysis patients? The pitfalls of the clinical examination in assessing volume status. Semin Dial 22(5):480–482. https://doi.org/10.1111/j.1525-139X.2009.00641.x
doi: 10.1111/j.1525-139X.2009.00641.x
pubmed: 19744155
Alexandrou M-E, Theodorakopoulou MP, Sarafidis PA (2022) Lung ultrasound as a tool to evaluate fluid accumulation in dialysis patients. Kidney Blood Press Res 47(3):163–176. https://doi.org/10.1159/000521691
doi: 10.1159/000521691
pubmed: 35008093
Covic A, Siriopol D, Voroneanu L (2018) Use of lung ultrasound for the assessment of volume status in CKD. Am J Kidney Dis 71(3):412–422. https://doi.org/10.1053/j.ajkd.2017.10.009
doi: 10.1053/j.ajkd.2017.10.009
pubmed: 29274919
Jaeger JQ, Mehta RL (1999) Assessment of dry weight in hemodialysis: an overview. J Am Soc Nephrol 10(2):392. https://doi.org/10.1681/ASN.V102392
doi: 10.1681/ASN.V102392
pubmed: 10215341
Zoccali C et al (2013) Pulmonary congestion predicts cardiac events and mortality in ESRD. J Am Soc Nephrol 24(4):639–646. https://doi.org/10.1681/ASN.2012100990
doi: 10.1681/ASN.2012100990
pubmed: 23449536
pmcid: 3609141
Mallamaci F et al (2010) Detection of pulmonary congestion by chest ultrasound in dialysis patients. JACC Cardiovasc Imaging 3(6):586–594. https://doi.org/10.1016/j.jcmg.2010.02.005
doi: 10.1016/j.jcmg.2010.02.005
pubmed: 20541714
Smargiassi A et al (2023) Vertical artifacts as lung ultrasound signs: trick or trap? Part 2- an accademia di ecografia toracica position paper on B-lines and sonographic interstitial syndrome. J Ultrasound Med 42(2):279–292. https://doi.org/10.1002/jum.16116
doi: 10.1002/jum.16116
pubmed: 36301623
Smargiassi A, Zanforlin A, Tursi F, Soldati G, Inchingolo R (2024) Trick or trap? Reply to vertical artifacts as lung ultrasound signs. J Ultrasound Med 43(1):215–216. https://doi.org/10.1002/jum.16337
doi: 10.1002/jum.16337
pubmed: 37732895
Jiang C, Patel S, Moses A, DeVita MV, Michelis MF (2017) Use of lung ultrasonography to determine the accuracy of clinically estimated dry weight in chronic hemodialysis patients. Int Urol Nephrol 49(12):2223–2230. https://doi.org/10.1007/s11255-017-1709-5
doi: 10.1007/s11255-017-1709-5
pubmed: 28975489
Zoccali C (2017) Lung ultrasound in the management of fluid volume in dialysis patients: potential usefulness. Semin Dial 30(1):6–9. https://doi.org/10.1111/sdi.12559
doi: 10.1111/sdi.12559
pubmed: 28043083
Gargani L et al (2016) Efficacy of a remote web-based lung ultrasound training for nephrologists and cardiologists: a LUST trial sub-project. Nephrol Dial Transplant 31(12):1982–1988. https://doi.org/10.1093/ndt/gfw329
doi: 10.1093/ndt/gfw329
pubmed: 27672089
Pardała A, Lupa M, Chudek J, Kolonko A (2019) Lung ultrasound B-lines occurrence in relation to left ventricular function and hydration status in hemodialysis patients. Medicina (Kaunas) 55(2):45. https://doi.org/10.3390/medicina55020045
doi: 10.3390/medicina55020045
pubmed: 30759793
Torino C et al (2016) The agreement between auscultation and lung ultrasound in hemodialysis patients: the LUST study. Clin J Am Soc Nephrol 11(11):2005–2011. https://doi.org/10.2215/CJN.03890416
doi: 10.2215/CJN.03890416
pubmed: 27660305
pmcid: 5108194
Loutradis C et al (2021) Ambulatory blood pressure changes with lung ultrasound-guided dry-weight reduction in hypertensive hemodialysis patients: 12-month results of a randomized controlled trial. J Hypertens 39(7):1444–1452. https://doi.org/10.1097/HJH.0000000000002818
doi: 10.1097/HJH.0000000000002818
pubmed: 34074973
Liang X-K, Li L-J, Wang X-H, Wang X-X, Wang Y-D, Xu Z-F (2019) Role of lung ultrasound in adjusting ultrafiltration volume in hemodialysis patients. Ultrasound Med Biol 45(3):732–740. https://doi.org/10.1016/j.ultrasmedbio.2018.10.025
doi: 10.1016/j.ultrasmedbio.2018.10.025
pubmed: 30558830
Vitturi N et al (2014) Lung ultrasound during hemodialysis: the role in the assessment of volume status. Int Urol Nephrol 46(1):169–174. https://doi.org/10.1007/s11255-013-0500-5
doi: 10.1007/s11255-013-0500-5
pubmed: 23884727
Sekiguchi H et al (2018) Central venous pressure and ultrasonographic measurement correlation and their associations with intradialytic adverse events in hospitalized patients: a prospective observational study. J Crit Care 44:168–174. https://doi.org/10.1016/j.jcrc.2017.10.039
doi: 10.1016/j.jcrc.2017.10.039
pubmed: 29132056
Ando Y, Yanagiba S, Asano Y (1995) The inferior vena cava diameter as a marker of dry weight in chronic hemodialyzed patients. Artif Organs 19(12):1237–1242. https://doi.org/10.1111/j.1525-1594.1995.tb02292.x
doi: 10.1111/j.1525-1594.1995.tb02292.x
pubmed: 8967881
Loutradis C, Sarafidis PA, Ferro CJ, Zoccali C (2021) Volume overload in hemodialysis: diagnosis, cardiovascular consequences, and management. Nephrol Dial Transplant 36(12):2182–2193. https://doi.org/10.1093/ndt/gfaa182
doi: 10.1093/ndt/gfaa182
pubmed: 33184659
Hur E et al (2013) Effect of fluid management guided by bioimpedance spectroscopy on cardiovascular parameters in hemodialysis patients: a randomized controlled trial. Am J Kidney Dis 61(6):957–965. https://doi.org/10.1053/j.ajkd.2012.12.017
doi: 10.1053/j.ajkd.2012.12.017
pubmed: 23415416
Thomasset A (1963) Bio-electric properties of tissues. Estimation by measurement of impedance of extracellular ionic strength and intracellular ionic strength in the clinic. Lyon Med 209:1325–1350
pubmed: 13981120
Jenin P, Lenoir J, Roullet C, Thomasset AL, Ducrot H (1975) Determination of body fluid compartments by electrical impedance measurements. Aviat Space Environ Med 46(2):152
pubmed: 1115713
The role of bioimpedance and biomarkers in helping to aid clinical decision-making of volume assessments in dialysis patients - PubMed’. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/24918155/ . Accessed 25 Apr 2023
Machek P, Jirka T, Moissl U, Chamney P, Wabel P (2010) Guided optimization of fluid status in haemodialysis patients. Nephrol Dial Transplant 25(2):538–544. https://doi.org/10.1093/ndt/gfp487
doi: 10.1093/ndt/gfp487
pubmed: 19793930
Onofriescu M et al (2014) Bioimpedance-guided fluid management in maintenance hemodialysis: a pilot randomized controlled trial. Am J Kidney Dis 64(1):111–118. https://doi.org/10.1053/j.ajkd.2014.01.420
doi: 10.1053/j.ajkd.2014.01.420
pubmed: 24583055
Basso F et al (2013) Comparison and reproducibility of techniques for fluid status assessment in chronic hemodialysis patients. Cardiorenal Med 3(2):104–112. https://doi.org/10.1159/000351008
doi: 10.1159/000351008
pubmed: 23922550
pmcid: 3721139