Predicting mortality in haemodialysis patients: a comparison between lung ultrasonography, bioimpedance data and echocardiography parameters

Siriopol, Dimitrie; Hogaş, Simona; Voroneanu, Luminița; Onofriescu, Mihai; Apetrii, Mugurel; Oleniuc, Mihaela; Moscalu, Mihaela; Sascău, Radu Andy; Covic, Adrian

doi:10.1093/ndt/gft260

Cited by 103 publications

(151 citation statements)

References 19 publications

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“…Comparing the studies of Mallamaci et al 16 and Siriopol et al, 4 we observe that cardiac function correlates with lung water only in the former. We suppose that the divergence related to the correlation between cardiac function, and lung congestion is partially explained by sample characteristics.…”

Section: Resultssupporting

confidence: 55%

“…In the multivariate analysis, only the IVC collapse index (b = 45.038; p < 0.001) and NYHA classes (b = 13.995; p = 0.006) were independent predictors of the number of B lines (Table 5). 4,15 we showed the lack of association between lung congestion and hydration status, as assessed by bioimpedance. This result leads to practical implications, since extracellular water assessed by bioimpedance is usually the guide for the ultra--filtration prescription of HD patients.…”

Section: Resultsmentioning

confidence: 79%

“…However, extracellular volemia as assessed by bioimpedance is very weakly associated with lung water. 4 Most importantly, extracellular and lung water were compared regarding their predictive power for adverse events. The conclusion is that lung water, and not extracellular water, is by far the most important predictor.…”

Section: Introductionmentioning

confidence: 99%

“…The conclusion is that lung water, and not extracellular water, is by far the most important predictor. 4 Thus, how can lung water be detected? Pulmonary capillary wedge pressure is the most reliable method to estimate extravascular lung water, but this method of assessment is highly invasive.…”

Section: Introductionmentioning

confidence: 99%

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Variables associated with lung congestion as assessed by chest ultrasound in diabetics undergoing hemodialysis

Santos¹,

Neto²,

Carneiro³

et al. 2017

Jornal Brasileiro De Nefrologia

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Section: Resultssupporting

confidence: 55%

Section: Resultsmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Variables associated with lung congestion as assessed by chest ultrasound in diabetics undergoing hemodialysis

Santos¹,

Neto²,

Carneiro³

et al. 2017

Jornal Brasileiro De Nefrologia

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“…Finally, the authors conclude that there are currently no studies in the literature reporting statistically significant data on the accuracy of US imaging in the assessment of hydration status in uremic patients: however, there have been several studies published about the usefulness of ultrasound of the lung and echocardiographic parameters in this setting [9][10][11][12][13][14]. While some studies have found that lung B-lines are strongly influenced by left ventricular function [15], our group confirmed correlation of lung ultrasound with hydration status also in well compensated hemodialysis patients [7].…”

mentioning

confidence: 97%

Usefulness of ultrasound imaging in overhydrated nephropathic patients

2016

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We read with interest the paper published in this journal by Prencipe et al. [1] reviewing the usefulness of ultrasound in the assessment of fluid overload in nephropathic patients. Although we agree on the general purpose of the authors to encourage the use of ultrasound in nephrology, we have some technical observations to point out.The first observation is about inferior vena cava (IVC) diameter measurements. The authors state that a collapsibility index (CI) above 0.75 suggests over-hydration, whereas a value below 0.4 would be consistent with dehydration: such assumption needs to be taken with caution. Indeed the IVC diameter and collapsibility depend on a number of variables, which include intravascular volume reflected by central venous pressure (CVP), but also left heart chambers pressure, intra-thoracic pressure and intraabdominal pressure. CVP, which is the main factor influencing IVC collapsibility has long been shown to be unreliable as a single indicator of body fluid status [2]. IVC collapsibility is also influenced by the contractile function of the heart downstream: even in a patient with normal intravascular volume the IVC can be collapsed owing to over-enhanced stroke volume [3], and on the other hand patients with heart failure have wide and non-collapsing IVC because of reduced heart contractile function [4]. It should also be observed that IVC reflects only the intravascular part of the body fluid volume [5]. Because of these limitations studies on IVC ultrasound to estimate volume status in dialysis patients have yielded conflicting results [5][6][7]. IVC ultrasound is certainly useful in assessing volume status, but its results should be put in the wider frame of all available clinical and ultrasound data, particularly about cardiac function-otherwise IVC diameters alone can be misleading.The second observation is about the statement that a study of the peritoneum in search of edema can also be performed with a high-frequency probe: it is certainly possible to identify superficial free fluid in this way, but only a low frequency probe has enough wavelength to scan deep regions of the abdomen and pelvis in search of free fluid [8]. Scanning with a linear probe risks to be insensitive, and the regular abdominal probe remains the preferred choice.Finally, the authors conclude that there are currently no studies in the literature reporting statistically significant data on the accuracy of US imaging in the assessment of hydration status in uremic patients: however, there have been several studies published about the usefulness of ultrasound of the lung and echocardiographic parameters in this setting [9][10][11][12][13][14]. While some studies have found that lung B-lines are strongly influenced by left ventricular function [15], our group confirmed correlation of lung ultrasound with hydration status also in well compensated hemodialysis patients [7].Even with these observations we congratulate the authors for their interesting review, and look forward for more studies on these subjects.

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