Lung Ultrasound to Diagnose Pulmonary Congestion Among Patients on Hemodialysis: Comparison of Full Versus Abbreviated Scanning Protocols

Reisinger, Nathaniel; Lohani, Sadichhya; Hagemeier, Jesper; Panebianco, Nova L.; Baston, Cameron

doi:10.1053/j.ajkd.2021.04.007

Cited by 19 publications

(20 citation statements)

References 26 publications

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“…The included articles in this study primarily applied 28 regional schemes for measurement, whereas the simplified 4-area and 8-area schemes in actual clinical applications were recommended for the international consensus LUS guidelines to evaluate pulmonary congestion [20]. The measured values of Area 4, Area 6 and Area 8 are highly consistent with the measured values of dialysis patients diagnosed with pulmonary congestion using Area 28 method [21,22]. Moreover, the consistency of the scores of the B-line between observers was relatively high, and there was no obvious difference in the B-line detection results of different types of ultrasound equipment [7].…”

Section: Discussionmentioning

confidence: 57%

Dynamic changes and prognosis of pulmonary congestion by lung ultrasound in hemodialysis patients: a systematic review and meta-analysis

Zhou

Hou

2023

Med Ultrason

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Aims: Lung ultrasound (LUS) has been rapidly developed to evaluate pulmonary extravascular fluid. A systematic review was conducted to study the dynamic changes of LUS findings of pulmonary congestion before and after hemodialysis and examine the application of LUS for the prognosis of hemodialysis patients.Material and methods: This study searched online databases for articles on hemodialysis patients that used LUS to evaluate dynamic changes during hemodialysis or prognosis. Articles published in English or Chinese until September 2021 with ≥30 patients were included in this study.Results: Of the 1329 articles, 14 met the inclusion criteria: 9 reported dynamic changes during dialysis in LUS (438 patients), and 5 reported the prognosis of hemodialysis patients in LUS (1274 patients). As indicated by a further meta-analysis, eight studies found that the combined standardized effect size was -0.74. The all-cause mortality rate of the dialysis patient group with high B-line scores was three times that of the dialysis patient group with low B-line scores. In dialysis patients, no difference was found between the LUS guided treatment and the conventional care in reducing the all-cause mortality (HR=0.92 95%CI: 0.67-1.27) and cardiovascular events (HR=0.98 95%CI: 0.72 -1.34).Conclusions: LUS can be used to effectively evaluate the volume status of hemodialysis patients in real time. The level of B-line before dialysis is significantly correlated with the poor prognosis. However, compared with the routine nursing group, the treatment of hemodialysis patients with LUS-guided volume management cannot effectively reduce mortality and cardiovascular events.

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Section: Discussionmentioning

confidence: 57%

Dynamic changes and prognosis of pulmonary congestion by lung ultrasound in hemodialysis patients: a systematic review and meta-analysis

Zhou

Hou

2023

Med Ultrason

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“…51 (28%) patients in the interventional arm died versus 59 (33%) in the usual care group (HR 0.99; 95% CI 0.61 -1.29). Despite not meeting the target enrollment, the study demonstrated reduction in B-line score in the intervention arm from a baseline of 15 B-lines on enrollment (95% CI 12-19) to 9 at study end (95% CI 5-12) compared with those in the control arm who had worsening pulmonary congestion with baseline B-line score of 16 (95% CI [13][14][15][16][17][18][19][20] rising to 30 at study end (95% CI [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. While there were no differences in pre-or post-dialysis blood pressures or left-ventricular mass index, ambulatory blood pressure monitoring was not undertaken as in the study by Loutradis.…”

Section: Interventional Studiesmentioning

confidence: 92%

“…They posit that a simplified heuristic of a B-line every other lung zone is suggestive of at least moderate pulmonary congestion and advocate the use of the 4-zone lung ultrasound which has AUC of up to 0.91 for prediction of the total B-line score. 26 Limitations: Quantitative lung ultrasonography has limitations in assessing extent of pulmonary congestion. Patients with diffuse parenchymal lung diseases such as idiopathic pulmonary fibrosis typically have findings of increased B-lines thought to originate from fibrosis at the level of the pulmonary alveolar interstitium.…”

Section: Technical Aspectsmentioning

confidence: 99%

Quantitative Lung Ultrasonography for the Nephrologist: Applications in Dialysis and Heart Failure

Reisinger

Koratala

2022

Kidney360

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Volume overload and its attendant increase in acute care utilization and cardiovascular morbidity and mortality represents a critical challenge for the practicing nephrologist. This is particularly true among patients with ESKD on HD where pre-dialysis volume overload and intradialytic and postdialytic hypovolemia account for almost a third of all cost for the Medicare dialysis benefit. Quantitative lung ultrasound is a tool for assessing the extent of extravascular lung water which outperforms physical exam and plain chest radiography. B-lines are vertical hyperechoic artifacts present in patients with increased extravascular lung water. B-lines have been shown to decrease dynamically during the hemodialysis treatment in proportion to ultrafiltration volume. Among patients with chronic heart failure, titration of diuretics based on the extent of pulmonary congestion noted on lung ultrasonography has been shown to decrease recurrent acute care utilization. Early data from randomized-controlled trials of lung ultrasound-guided ultrafiltration therapy among patients with ESKD on HD have shown promise for potential reduction in recurrent episodes of decompensated heart failure and cardiovascular events. Ultimately lung ultrasound may predict those who are ultrafiltration tolerant and could be used to decreased acute care utilization and thus cost in this population.

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“…Traditionally, the standard 28-site LUS score system developed by Jambrik et al has been widely adopted to detect interstitial lung water by counting the B lines manually [ 7 ]. Studies have shown that a simplified method of LUS using 8 points compared to the traditional 28-point method has a good correlation [ 8 , 9 ]. It reduces time and complexity to perform and is better suited for everyday clinical practice in dialysis units [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Automated lung ultrasound image assessment using artificial intelligence to identify fluid overload in dialysis patients

Tan

Liu

et al. 2022

BMC Nephrol

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Background Fluid assessment is challenging, and fluid overload poses a significant problem among dialysis patients, with pulmonary oedema being the most serious consequence. Our study aims to develop a simple objective fluid assessment strategy using lung ultrasound (LUS) and artificial intelligence (AI) to assess the fluid status of dialysis patients. Methods This was a single-centre study of 76 hemodialysis and peritoneal dialysis patients carried out between July 2020 to May 2022. The fluid status of dialysis patients was assessed via a simplified 8-point LUS method using a portable handheld ultrasound device (HHUSD), clinical examination and bioimpedance analysis (BIA). The primary outcome was the performance of 8-point LUS using a portable HHUSD in diagnosing fluid overload compared to physical examination and BIA. The secondary outcome was to develop and validate a novel AI software program to quantify B-line count and assess the fluid status of dialysis patients. Results Our study showed a moderate correlation between LUS B-line count and fluid overload assessed by clinical examination (r = 0.475, p < 0.001) and BIA (r = 0.356. p < 0.001). The use of AI to detect B-lines on LUS in our study for dialysis patients was shown to have good agreement with LUS B lines observed by physicians; (r = 0.825, p < 0.001) for the training dataset and (r = 0.844, p < 0.001) for the validation dataset. Conclusion Our study confirms that 8-point LUS using HHUSD, with AI-based detection of B lines, can provide clinically useful information on the assessment of hydration status and diagnosis of fluid overload for dialysis patients in a user-friendly and time-efficient way.

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Lung Ultrasound to Diagnose Pulmonary Congestion Among Patients on Hemodialysis: Comparison of Full Versus Abbreviated Scanning Protocols

Cited by 19 publications

References 26 publications

Dynamic changes and prognosis of pulmonary congestion by lung ultrasound in hemodialysis patients: a systematic review and meta-analysis

Dynamic changes and prognosis of pulmonary congestion by lung ultrasound in hemodialysis patients: a systematic review and meta-analysis

Quantitative Lung Ultrasonography for the Nephrologist: Applications in Dialysis and Heart Failure

Automated lung ultrasound image assessment using artificial intelligence to identify fluid overload in dialysis patients

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