Lung Ultrasound Estimates the Overhydration and Benefits Blood Pressure Control in Normal or Mild Symptomatic Hemodialysis Patients

Abstract

Akeatit Trirattanapikul,1 Sawinee Kongpetch,2,3 Eakalak Lukkanalikitkul,2,3 Anucha Ahooja,4 Patamapon Seesuk,3 Amod Sharma,5 Sirirat Anutrakulchai2,5 1Department of Medicine, Mahidol University, Bangkok, Thailand; 2Deparment of Medicine, Khon Kaen University, Khon Kaen, Thailand; 3Center of Excellence in Kidney Diseases, Khon Kaen University, Khon Kaen, Thailand; 4Department of Radiology, Khon Kaen University, Khon Kaen, Thailand; 5Chronic Kidney Disease Prevention in the Northeast of Thailand (CKDNET) Project, Khon Kaen University, Khon Kaen, ThailandCorrespondence: Sirirat Anutrakulchai, Division of Nephrology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand, Email [email protected]; [email protected]: Lung ultrasound (LUS) is used for dry weight guidance by assessment of pulmonary congestion in hemodialysis (HD) patients. The aim of this study was to estimate amounts of accumulated fluid by total LUS scores (TLUSS), which were scarcely reported in HD patients who were normal or had a mild functional abnormality. In addition, the correlations between the LUS score of each area and TLUSS were determined to suggest fewer specific areas valuable to shorten the examination time of LUS.Methods: This cohort study was conducted in adult HD patients who have New York Heart Association Classes I–II. LUS and multifrequency bioimpedance (BIA) were performed at baseline and the individual prescribed dry weight was set. Then each LUS was conducted at 28 areas of bilateral intercostal spaces and calculated as TLUSS weekly for eight weeks in which dry weight was adjusted. The second BIA was also measured at week eight. The difference of pre-HD weight and target weight (weight gain; WG) represented the amount of fluid accumulation.Results: Twenty patients with a mean age of 62.2± 14.0 years were enrolled. One hundred and sixty-six LUS were performed in which forty episodes of them were simultaneously measured with BIA. Optimum dry weight adjusted by TLUSS which benefited in mean reductions of blood pressure, and cardiothoracic ratios. WG amounts were significantly correlated with TLUSS (r=0.38), and with extracellular fluid (r=0.35) and overhydration fluid (r=0.39) assessed by BIA. Estimations of mean fluid overload were 2.18 (TLUSS ≤ 15), 2.72 (TLUSS 16– 24), 3.17 (TLUSS 25– 33), 3.65 (TLUSS 34– 38) and 5.03 (TLUSS ≥ 39) in liters. The cut-off points of sum scores of 12 specific lung areas represented the none-mild were 16.Conclusion: TLUSS estimated accumulated fluid useful for volume and blood pressure controls. Performance of LUS in 12 specific lung areas may reduce spending time and support routine uses of LUS in clinical practice.Keywords: lung ultrasonography, bioelectrical impedance analysis, volume status, hemodialysis

Keywords

• lung ultrasonography
• bioelectrical impedance analysis
• volume status
• hemodialysis