Article metrics

  • citations in SCindeks: 0
  • citations in CrossRef:0
  • citations in Google Scholar:[=>]
  • visits in previous 30 days:13
  • full-text downloads in 30 days:3
article: 2 from 4  
Back back to result list
Medicinski pregled
2018, vol. 71, iss. 5-6, pp. 187-190
article language: English
document type: Case Report
doi:10.2298/MPNS1806187V


Lung ultrasound in the assessment of hypervolemia in hemodialysis patients: Two case reports
aGeneral Hospital Kikinda
bInstitute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica + University of Novi Sad, Faculty of Medicine
cUniversity of Novi Sad, Faculty of Medicine + Clinical Center of Vojvodina, Clinic of Nephrology and Clinical Immunology, Novi Sad

e-mail: veselinov.vladimir@gmail.com

Abstract

Introduction. Hemodialysis patients often have chronic volume overload, hypervolemia, which may cause severe complications. In some patients hypervolemia is masked, without any signs and symptoms, such as hypertension, edema and bibasilar crackles on lung auscultation. Lung ultrasound can be used to detect these patients. Pre- and post-dialysis lung ultrasound can be used to quantify lung congestion using the B line score. High post-dialysis B line score can identify patients with residual hypervolemia and adequate measures can be taken (increasing ultrafiltration, extended duration of hemodialysis, additional dialysis sessions). Case Reports. The first patient was a 57-year-old male. The hemodialysis vintage was 4 years. His interdialytic weight gain was 2.8 kg. The lung ultrasound was performed before and after dialysis and B line score was calculated. The pre-dialysis score was 15 and post-dialysis score was 2. The second patient was a 72-year-old male. The hemodialysis started 5 years before. This patient was noncompliant with the medical advice of his physician regarding diet and medications. His interdialytic weight gain was 5.6 kg. His pre-dialysis score was 26 and post-dialysis score was 15. Both patients were without signs and symptoms of hypervolemia after dialysis. Nevertheless, the second patient was 1.6 kg over his dry weight after dialysis. An additional dialysis session was scheduled, after which his post-dialysis B line score fell to 5. Conclusion. Lung ultrasound can be used to assess volume status in dialysis patients. It can identify hypervolemia in asymptomatic patients and allow necessary corrections.

Keywords

References

Agarwal, R., Weir, M.R. (2010) Dry-Weight: A Concept Revisited in an Effort to Avoid Medication-Directed Approaches for Blood Pressure Control in Hemodialysis Patients. Clinical Journal of the American Society of Nephrology, 5(7): 1255-1260
Basso, F., Milan, M.S., Cruz, D.N., Teixeira, C., Brendolan, A., Nalesso, F., Zanella, M., Ronco, C. (2013) Comparison and Reproducibility of Techniques for Fluid Status Assessment in Chronic Hemodialysis Patients. Cardiorenal Medicine, 3(2): 104-112
Đurić, P.S., Đurić, Ž., Janković, A., Tošić, J., Popović, J., Dimković, N. (2014) Influence of hemodialysis duration per week on parameters of dialysis adequacy and cardiovascular morbidity. Medicinski pregled, vol. 67, br. 11-12, str. 385-391
Gargani, L., Volpicelli, G. (2014) How I do it: Lung ultrasound. Cardiovascular Ultrasound, 12(1): 25
Ishigami, J., Iimori, S., Kuwahara, M., Sasaki, S., Tsukamoto, Y. (2014) Diagnostic value of B-type natriuretic peptide for estimating left atrial size and its usefulness for predicting all-cause mortality and cardiovascular events among chronic haemodialysis patients. Nephrology, 19(12): 777-783
Lichtenstein, D., Axler, O. (1993) Intensive use of general ultrasound in the intensive care unit. Intensive Care Medicine, 19(6): 353-355
Mallamaci, F., Benedetto, F.A., Tripepi, R., Rastelli, S., Castellino, P., Tripepi, G., Picano, E., Zoccali, C. (2010) Detection of Pulmonary Congestion by Chest Ultrasound in Dialysis Patients. JACC: Cardiovascular Imaging, 3(6): 586-594
Noble, V.E., Murray, A.F., Capp, R., Sylvia-Reardon, M.H., Steele, D.J.R., Liteplo, A. (2009) Ultrasound Assessment for Extravascular Lung Water in Patients Undergoing Hemodialysis. Chest, 135(6): 1433-1439
Oei, E.L., Fan, S.L. (2015) Practical Aspects of Volume Control in Chronic Kidney Disease Using Whole Body Bioimpedance. Blood Purification, 39(1-3): 32-36
Picano, E., Pellikka, P.A. (2016) Ultrasound of extravascular lung water: a new standard for pulmonary congestion. European Heart Journal, 37(27): 2097-2104
Siriopol, D., Hogas, S., Voroneanu, L., Onofriescu, M., Apetrii, M., Oleniuc, M., Moscalu, M., Sascau, R., Covic, A. (2013) Predicting mortality in haemodialysis patients: a comparison between lung ultrasonography, bioimpedance data and echocardiography parameters. Nephrology Dialysis Transplantation, 28(11): 2851-2859
Torino, C., Gargani, L., Sicari, R., Letachowicz, K., Ekart, R., Fliser, D., Covic, A., Siamopoulos, K., Stavroulopoulos, A., Massy, Z.A., Fiaccadori, E., Caiazza, A., Bachelet, T., Slotki, I., Martinez-Castelao, A., Coudert-Krier, M.-J., Rossignol, P. (2016) The Agreement between Auscultation and Lung Ultrasound in Hemodialysis Patients: The LUST Study. Clinical Journal of the American Society of Nephrology, 11(11): 2005-2011
Trezzi, M., Torzillo, D., Ceriani, E., Costantino, G., Caruso, S., Damavandi, P.T., Genderini, A., Cicardi, M., Montano, N., Cogliati, C. (2013) Lung ultrasonography for the assessment of rapid extravascular water variation: evidence from hemodialysis patients. Internal and Emergency Medicine, 8(5): 409-415
Vitturi, N., Dugo, M., Soattin, M., Simoni, F., Maresca, L., Zagatti, R., Maresca, M.C. (2014) Lung ultrasound during hemodialysis: the role in the assessment of volume status. International Urology and Nephrology, 46(1): 169-174
Xirouchaki, N., Georgopoulos, D. (2007) The use of lung ultrasound: a brief review for critical care physicians and pneumonologists. Pneumon, 20(2): 134-41
Zoccali, C., Torino, C., Tripepi, R., Tripepi, G., d'Arrigo G., Postorino, M., Gargani, L., Sicari, R., Picano, E., Mallamaci, F. (2013) Pulmonary Congestion Predicts Cardiac Events and Mortality in ESRD. Journal of the American Society of Nephrology, 24(4): 639-646
Zoccali, C., Tripepi, R., Torino, C., Bellantoni, M., Tripepi, G., Mallamaci, F. (2013) Lung Congestion as a Risk Factor in End-Stage Renal Disease. Blood Purification, 36(3-4): 184-191