Assessment of Volume Status in Chronic Hemodialysis: Comparison of Lung Ultrasound to Clinical Practice and Bioimpedance
1
Issued Date
2023-01-01
Resource Type
eISSN
22288082
Scopus ID
2-s2.0-85151840644
Journal Title
Siriraj Medical Journal
Volume
75
Issue
3
Start Page
224
End Page
233
Rights Holder(s)
SCOPUS
Bibliographic Citation
Siriraj Medical Journal Vol.75 No.3 (2023) , 224-233
Suggested Citation
Vareesangthip K., Thanapattaraborisuth B., Chanchairujira K., Wonglaksanapimon S., Chanchairujira T. Assessment of Volume Status in Chronic Hemodialysis: Comparison of Lung Ultrasound to Clinical Practice and Bioimpedance. Siriraj Medical Journal Vol.75 No.3 (2023) , 224-233. 233. doi:10.33192/smj.v75i3.261016 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/82524
Title
Assessment of Volume Status in Chronic Hemodialysis: Comparison of Lung Ultrasound to Clinical Practice and Bioimpedance
Author's Affiliation
Other Contributor(s)
Abstract
Objective: Lung ultrasonography (LUS) has recently been used to evaluate extravascular lung water, and shown to be able to predict all-cause mortality in hemodialysis (HD) patients. This study aim to compare LUS with other volume assessment methods, and to verify the prognostic value of LUS in Thai chronic HD patients. Materials and Methods: We conducted a prospective cohort study in 36 chronic HD patients. Volume status before the HD session was evaluated by physical examinations, bioimpedance analysis (BIA), and ultrasound lung comets (ULCs). Mortality and morbidities were recorded during a 1-year follow-up period. Results: The degree of lung fluid accumulation was assessed by summation of the number of ULCs, and was classified into 3 groups: mild-to-moderate (ULC<15–29), severe (ULC=30–59), and very severe (ULC≥60) in 11.1%, 77.8%, and 11.1% of the patients, respectively. Either clinical edema or lung crackle had low sensitivity (20-32%) to detect extravascular lung water excess in patient with mild-to-moderate ULC and severe ULC. Overhydration assessed by BIA was found in 75% and 64.3% of patients with mild-to-moderate and severe ULC, respecively. In patients with very severe ULC, the admission rate due to volume overload was significantly higher, there was also a trend of increased mortality, as well as intradialytic complications. Conclusion: Clinical assessment and BIA have limited value in determining extravascular fluid excess in the lung. Lung ultrasound is a useful tool to detect subclinical pulmonary congestion. The long-term outcome by using LUS-guided fluid management needs larger population studies.