Objectives: To elucidate the role of lung ultrasound in assessment of subclinical fluid overload in hemodialysis (HD) patients. Background: Volume overload has a significant role in HD patients with difficult blood pressure control. The clinical evaluation of fluid status is challenging and has poor diagnostic accuracy. Extravascular lung water (ELW) represents an important element of body fluid volume. Lung ultrasound (LUS) is increasingly used for ELW assessment through the analysis of B-lines artifacts. Methods: Eighty-eight HD patients were followed up prospectively. Patients were divided into 3 groups according to the changes of systolic blood pressure (SBP) during HD sessions. Group (1): patients with intra-dialytic hypertension (n = 12), group (2): patients with intra-dialytic hypotension (n = 28) and group (3): patients with no significant blood pressure variabilities (n = 48). Numbers of B-lines were measured by LUS and IVC diameters were measured pre and post-dialysis. In addition, Endothelin-1 (ET-1) and other routine laboratory tests were done. Results: There were significant increases in the number of B-lines and IVC diameter pre and post-dialysis in group (1) compared to the other two groups. There was significant decrease in post dialysis IVC diameter but not the number of B-lines in group (2) compared with the other two groups. ET-1 level was significantly increased in group 1 compared to the other two groups. There was a statistically significant positive correlation between the pre-dialysis number of B-lines and ET-1. Conclusion: Lung ultrasound can be considered a sensitive and specific modality for volume assessment in HD patients especially with intra-dialytic hypertension. We recommend serial LUS as a part of management in this group of patients.

Objectives: To estimate the prevalence of chronic kidney disease (CKD) in first and second degree relatives of Hemodialysis patients. Background: Early detection and intervention of chronic kidney disease (CKD) may prevent or delay the progression and achieve improved patient outcomes. Family members of end-stage renal disease (ESRD) patients are considered as a high-risk population for CKD. The aim of this work is to screen and estimate the prevalence of chronic kidney disease in first and second degree relatives of hemodialysis patients. Methods: This is an observational prospective study carried out in Nephrology Unit, Internal Medicine Department, Menoufia University Hospital during January 2019 to January 2020. First and second degree relatives of ESRD were included. Relatives with known CKD risk factors or relative to ESRD with known hereditary disease were excluded. Serum creatinine and estimated eGFR, albumin creatinine ratio (ACR) and abdominal ultrasound were done twice with 3 months apart to screen for CKD. Results: 321 persons from first and second degree relatives of chronic hemodialysis patients were included. CKD prevalence was 5.6% Comparison between CKD group and non CKD showed no statistically significant difference as regard age, Gender, Smoking, BMI, and degree of relatives. There were highly significant difference between the studied groups as regard serum creatinine, bloodurea, eGFR and ACR. Relatives of ESRD patients of unknown etiology showed highly significant difference to develop CKD (44.4%) compared to non CKD group 11.5% with P value < 0.0001. Conclusions: Prevalence of CKD in relatives-without any CKD risk factors-to ESRD was 5.6%. Family members of ESRD should be screened for CKD, especially relatives to ESRD of unknown etiology.