Study the Role of Lung Ultrasound in Assessment of Subclinical Fluid Overload in Maintenance Hemodialysis Patients with Intra-Dialytic Hypertension

Abstract

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.

Role of Lung Ultrasound in the Assessment of Hydration Status of Chronic Haemodialysis Patients

“…This is similar to findings by Siriopol et al [9], Khamis et al [20] and Mallamaci et al [22]. Whereas Vitturi et al [24] obtained a relatively low number of B-lines, and they described a high correlation between the decrease in the number of B-lines and weight loss after dialysis.…”

“…B-lines are associated with the accumulation of water during the interdialytic period and reflect the variation in the level of extravascular lung water which occurs during dialysis [32]. In their study, Khamis et al also showed a significant decrease of number of B-lines post-dialysis, especially for the group of patient with interdialytic hypertension (from 10 to 4 B-lines) [20]. Noble et al [33] and Mallamaci et al [22] proved that the number of B-lines rapidly and in a reliable manner reflects the extracellular fluid variation, with an average duration of 4 minutes for the change on the screen [22].…”

“…Lung ultrasound through the detection of B-lines has been described as an assessment method of HD patients' hydration status and is much more used in determining lung extravascular fluid volume [9] [10] [20]. Lung ultrasound can evaluate extravascular lung water by identifying B-lines, which are vertical artifacts arising from the pleural line, extending to the edge of the screen, and which move synchronously with respiratory.…”

The Relationship between Sleep Quality and Hemodialysis and Nursing Intervention in Uremia Patients Based on Intelligent Data

“…According to a research report, sleep disturbance is one of the six most troublesome symptoms of hemodialysis patients, and the prevalence rate is as high as 86%. This seriously affects the quality of life of patients and increases the risk of death in dialysis patients and affects disease prognosis [ 15 ].…”