Abstract
Fluid overload is associated with adverse outcomes in hemodialysis (HD) patients. Two bedside methods are increasingly utilized to evaluate objectively fluid status—bioimpedance and lung ultrasonography, but there is no available direct, head-to-head comparison of their prognostic significance. Importantly, their predictive abilities have never been tested in a HD population, alongside those of a classic model that also incorporates established echocardiographic parameters of increased mortality risk. Between 26 May 2011 and 26 October 2012, we included in the study 173 patients undergoing chronic HD treatment for at least 3 months in a single dialysis unit. Relative fluid overload (RFO) and B-lines score (BLS) were used as candidate predictors. From Cox survival analysis we evaluated the increase in the predictive abilities for all-cause mortality of adding continuous RFO or BLS to a model including conventional predictors . 31 patients (17.9 %) died during a median follow-up of 21.3 (interquartile range 19.9–30.3) months. All Cox models showed good calibration. The C statistic for the all-cause mortality prediction increased significantly when the RFO was included into the baseline model (ΔC statistics 0.058 95 %CI = 0.003–0.114), but not when the BLS was included into the baseline model. Only the model that incorporated RFO showed significantly better risk reclassification abilities than the baseline model (IDI = 3.6 % and continuous NRI = 24.8 %). Fluid overload, as assessed by bioimpedance, and not by lung ultrasonography, improves risk prediction for death, beyond classical and echocardiographic-based risk prediction scores/parameters.
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Acknowledgments
This study was partially funded by the University of Medicine and Pharmacy Iasi, Grant number IDEI—PCE 2011, PN-II-ID-PCE-2011-3-0637.
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Prof. Dr. Adrian Covic is an honorary speaker for Fresenius Medical Care. Fresenius Medical Care is the manufacturer of the BCM® device and was not involved in any way in the study. The other authors have nothing to declare.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Supplementary Figure 1
Images from the ultrasound scanning in two areas from one patient from our study, showing 0 (A) and 2 B-lines (B) (tiff 214 kb)
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Siriopol, D., Voroneanu, L., Hogas, S. et al. Bioimpedance analysis versus lung ultrasonography for optimal risk prediction in hemodialysis patients. Int J Cardiovasc Imaging 32, 263–270 (2016). https://doi.org/10.1007/s10554-015-0768-x
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DOI: https://doi.org/10.1007/s10554-015-0768-x