Detection Of Pulmonary Congestion And The Assessment Of Volume Status By Lung Ultrasound In Hemodialysis Patients

Purpose:To evaluate the pulmonary congestion in patients with maintenance hemodialysis(MHD)by lung ultrasound(LUS),and to analyze the related factors of pulmonary congestion,and to evaluate the clinical value of lung ultrasound in evaluating the volume of hemodialysis patients.Methods:From March 2017 to October 2017,we seclected 62 patients with maintenance hemodialysis in the hemodialysis center of Second Hospital of Jilin University.Among them,there were 32 males and 30 females.The patients were divided into three groups according to the B lines evaluation methods by lung ultrasound: 22 cases were no or mild pulmonary congestion(B lines less than 15),20 cases were moderate pulmonary congestion(B lines:16-30)and 20 cases were severe pulmonary congestion(B lines more than 30),besides,setting up the control group before and after dialysis.Before and after dialysis about 1 hour,the examination of LUS,echocardiography and the inferior vena cava were taken.First,the examinations were performed in the supine position.Scaning of the anterior and lateral chest was performed on both sides of the chest,from the second to the fourth(on the right side to the fifth)intercostal space.The number of B-lines was counted in each scan at the parasternal,midclavicular,anterior axillary and midaxillary lines(28 total sectors examined).Then in the left lateral position for echocardiography,the echocardiography paramaters include LAD,LVEDV,LVEF,E,E/Ea and PASP were measured.Then the inferior vena cava was explored in the subxiphoid window in its sagittal view,the diameters of the vessel were measured the maximum diameter at non-forced end-expiratory phases within 2cm from the right atrium.We measured three times and calculated mean value as the IVCD.The IVCDi was measured by dividing IVCD by the body surface area.At last,we collected data such as height,dry weight,body weight before and after dialysis and the change of blood pressure and heart rate,and then calculated the weight gain,residual weight,weight loss and body surface area.Statistical analysis of the data were performed by EXCEL and SPSS20.0 statistical software,a P value of <0.05 was considered significant.Results:1.Pulmonary congestion was common in the MHD patients.The incidence of moderate and severe pulmonary congestion was about 64.5%,and the incidence of asymptomatic pulmonary congestion was about 38.7%.2.Compared with no or mild pulmonary congestion group and moderate pulmonary congestion group,diabetes and heart function III level was significantly higher,the heart rate increased significantly,serum albumin was significantly decreased in the severe pulmonary congestion group(P<0.05);compared with no or mild pulmonary congestion group,LVEF significantly decreased,E/Ea and pulmonary arterial pressure increased significantly in the severe pulmonary congestion group and moderate pulmonary congestion(P<0.05).3.B line score and diabetes(r=0.317,P=0.003),NYHA class III(r=0.299,P=0.005),heart rate(r=0.344,P=0.006),E/Ea(r=0.579,P<0.001)and PASP(rho=0.587,P<0.001)had positively correlation(P<0.05)and had negatively correlation with hemoglobin(r=-0.312,p=0.014),the serum albumin(r=-0.555,P<0.001),LVEF(rho=-0.633,P<0.001),and had no significant correlation with other variables(r<0.2)。4.The changes of B line score,weight,IVCD and IVCDi before and after dialysis were significant(P<0.001).The pre-dialysis B line score had significant positively correlation with weight gain(r=0.517,P<0.001);the post-dialysis B line score had positively correlation with residual weight(r=0.351,P=0.005);the B-lines reduction had positively correlation with the weight change before and after dialysis(r=0.338,P=0.007).5.Patients were characterized normohydrated if IVCDi was between 8 and 11.5mm/m2,and overhydrated if IVCDi >11.5mm/m2,at last,B line score AUC is 0.832,95% confidence interval: 0.734-0.930,optimal cut-off is 11.5.When the B line score greater than or equal to 11.5,the diagnostic sensitivity was 93.3%,specificity was 74.5%.Conculsions:1.Pulmonary congestion has a high incidence in MHD patients.Pulmonary ultrasound can semi-quantitatively evaluate the pulmonary congestion in dialysis patients and help to detect pulmonary congestion without clinical symptoms,especially in patients with diabetes mellitus,poor heart function,high pulmonary arterial pressure and hypoalbuminemia.2.Lung ultrasound B line score has a certain relationship with weight change during dialysis,lung ultrasound may contribute to the assessment of dry weight.3.Pulmonary ultrasound is a simple,reliable,convenient and noninvasive tool for assessing the status of hemodialysis patients.