Background: In recent years, the use of chest ultrasonography to detect lung water has received growing attention in clinical research. Estimation of the number of B-lines using lung ultrasound is now a standard method for the evaluation of pulmonary congestion. In the present study, we examined the relation between the number of B-lines and clinical parameters in hemodialysis patients. Methods: A total of 49 consecutive patients receiving maintenance hemodialysis were enrolled in this study. Lung ultrasound was performed using Vscan® (GE Healthcare, Japan). Bilateral scanning of the anterior and lateral chest walls was performed with the patient in a supine position just after the start of the hemodialysis therapy. The total number of B-lines was estimated. We investigated the relationships between the number of B-lines and other clinical parameters. Results: Patient heart rate and the serum log [NT-proBNP] level were positively correlated (P = 0.009 and 0.003, respectively), and body weight and the serum albumin and creatinine level were negatively correlated with the number of B-lines (P = 0.023, 0.001, and 0.011, respectively). Conclusions: The number of B-lines was positively correlated with the serum N-terminal pro-brain natriuretic peptide level. Lung ultrasound can quantify lung edema. Body weight and the serum albumin and creatinine level were negatively correlated with the number of B-lines. Careful attention to the presence of pulmonary edema is needed in patients with a low body weight and a low serum albumin and creatinine level.

A 71-year-old Japanese woman presented with progressive fatigue, lethargy, dysarthria and a gait disorder. Her laboratory data revealed hyponatremia (Na 101 mEq/L), and we started correcting her serum sodium level. Within a few days, she became comatose, bedridden, and was intubated. We diagnosed osmotic demyelination syndrome (ODS) and started performing plasma exchange (PE) on the 39th day of hospitalization. She fully recovered after starting PE, and was discharged on foot unassisted. PE can be a beneficial treatment in patients with chronic ODS.

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