Xin yixue (Sep 2023)

Association of extravascular lung water with clinical outcomes in stages 4 and 5 chronic kidney diseases: a prospective cohort study

  • Wang Jiawei, Luo Qiong, Lu Laishun, Hong Chunyan, Tang Xiaoling

DOI
https://doi.org/10.3969/j.issn.0253-9802.2023.09.010
Journal volume & issue
Vol. 54, no. 9
pp. 660 – 665

Abstract

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Objective To evaluate the impact of extravascular lung water volume on cardiovascular events， renal replacement therapy and mortality in pre-dialysis patients with stages 4 and 5 chronic kidney diseases. Methods In this prospective cohort study， 237 patients with stages 4 and 5 chronic kidney diseases who had not received renal replacement therapy were enrolled. All patients were divided into the non- or mild-pulmonary congestion group （defined by the number of B-lines<15 in lung ultrasonography） and the moderate or severe pulmonary congestion group （B-lines≥15）. During subsequent follow-up， clinical prognosis was compared between two groups. Results Among 237 patients， 78 （32.9%） were diagnosed with moderate or severe pulmonary congestion. In the moderate or severe pulmonary congestion group， the proportion of patients complicated with cardiovascular diseases was significantly higher （47.4% vs. 27.7%， P < 0.05） and the ejection fraction was significantly lower（（63±9） % vs. （66±6） %， P < 0.05） than those in the non- or mild-pulmonary congestion group. During a median follow-up of 14.4 （range： 7.4， 24.5） months， 84 （35.4%） had cardiovascular events， 115 （48.5%） initiated renal replacement therapy， and 22 （9.3%） died. Multivariate Cox’s regression analysis showed that patients in the moderate or severe pulmonary congestion group had a higher risk of cardiovascular events （adjusted hazard ratio （HR）： 2.496 （1.598-3.897）， P < 0.001）， higher proportion of renal replacement therapy （HR： 1.739 （1.182-2.558）， P=0.005）， and higher mortality （HR： 3.156 （1.325-7.516）， P = 0.009） compared with those in the non- or mild-pulmonary congestion group. Conclusions These findings suggest that extravascular lung water volume assessed by lung ultrasonography can predict adverse outcomes， such as cardiovascular events， initiating renal replacement therapy and death， in non-dialysis-dependent patients with stages 4 and 5 chronic kidney diseases， which is helpful for stratification of clinical prognosis in this population.

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