Current opinion in quantitative lung ultrasound for the nephrologist

Abstract

Purpose of review Volume overload mediates worse cardiovascular outcomes in patients with end-stage kidney disease (ESKD) on hemodialysis (HD), leading to increased acute care utilization. Understanding the presence of pulmonary congestion, which is often clinically silent, could be instrumental in predicting acute care needs and mitigating risks through appropriate therapy. This review provides an overview of the existing literature on lung ultrasound in ESKD patients. Recent findings Quantitative lung ultrasound predicts adverse cardiovascular outcomes in ESKD patients on HD. The largest randomized controlled trial of a lung ultrasound-guided ultrafiltration strategy demonstrated control of pulmonary congestion without an increased risk of intradialytic hypotension, arrhythmia, or access thrombosis. Despite this, the study was negative in the incidence of the primary composite endpoint of all-cause death, nonfatal myocardial infarction, and decompensated heart failure. A post hoc analysis showed promise with reductions in recurrent acute care utilization and cardiovascular events. Recent research has focused on simplification of the 28-zone lung ultrasound, and abbreviated protocols have been shown to retain prognostic ability. Summary Lung ultrasound is a valuable tool for nephrologists to diagnose and manage pulmonary congestion. However, its optimal integration with other hemodynamic parameters to formulate effective management strategies remains elusive. Future studies should address these gaps and find solutions to the training inadequacies in clinician-performed ultrasound.

Nuances of Point-of-Care Ultrasound in Nephrology: A Clarion Call for Deeper Understanding

“…Much like IVC ultrasound, lung ultrasound (LUS) is frequently misapplied to infer volume status. LUS is gaining popularity among nephrologists due to its technical simplicity and several studies in hemodialysis patients demonstrating its diagnostic superiority and prognostic significance [12]. Nevertheless, one must be aware that LUS only reflects left heart pressures, neglecting the other components of the hemodynamic circuit, that is, forward flow and right heart pressures.…”