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Lung ultrasound during hemodialysis: the role in the assessment of volume status

  • Nephrology - Original Paper
  • Published:
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Abstract

Objective

Fluid balance is important in patients undergoing hemodialysis. “Dry” weight is usually estimated clinically, and also, bioimpedance is considered reliable. Ultrasonography of inferior vena cava (IVC) estimates central venous pressure, and lung ultrasound evaluates extravascular (counting B-lines artifact) lung water. Our study was aimed to clarify their usefulness in the assessment of volume status during hemodialysis.

Methods

A total of 71 consecutive patients undergoing hemodialysis underwent lung and IVC ultrasound and bioimpedance spectroscopy immediately before and after dialysis.

Results

There was a significant reduction in the number of B-lines (3.13 vs 1.41) and in IVC diameters (end-expiratory diameter 1.71 vs 1.37; end-inspiratory diameter 1.19 vs 0.95) during dialysis. The reduction in B-lines correlated with weight reduction during dialysis (p 0.007); none of the parameters concerning the IVC correlated with fluid removal. At the end of the dialysis session, the total number of B-lines correlated with bioimpedance residual weight (p 0.002).

Discussion

The reduction in B-lines correlated with fluid loss due to hemodialysis, despite the small pre-dialysis number, confirming that lung ultrasound can identify even modest variations in extravascular lung water. IVC ultrasound, which reflects the intravascular filling grade, might not be sensitive enough to detect rapid volume decrease. Clinically estimated dry weight had a poor correlation with both bioimpedance and ultrasound techniques. Post-dialysis B-lines number correlates with residual weight assessed with bioimpedance, suggesting a role for ultrasound in managing hemodialysis patients.

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Acknowledgments

All authors have contributed significantly, and all authors are in agreement with the content of the manuscript. MS, FS and LM performed the ultrasound examinations; NV reviewed all the examinations and analyzed the data; MD, RZ and MCM performed the bioimpedance analysis.

Conflict of interest

The authors declare that they have no relevant financial interests nor conflict of interest.

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Authors and Affiliations

  1. Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy

    Nicola Vitturi, Marta Soattin, Francesco Simoni & Luisa Maresca

  2. Renal Unit, Ca’ Foncello Hospital, Treviso, Italy

    Mauro Dugo, Riccardo Zagatti & Maria Cristina Maresca

Authors
  1. Nicola Vitturi
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  2. Mauro Dugo
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  3. Marta Soattin
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  4. Francesco Simoni
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  5. Luisa Maresca
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  6. Riccardo Zagatti
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  7. Maria Cristina Maresca
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Corresponding author

Correspondence to Nicola Vitturi.

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Vitturi, N., Dugo, M., Soattin, M. et al. Lung ultrasound during hemodialysis: the role in the assessment of volume status. Int Urol Nephrol 46, 169–174 (2014). https://doi.org/10.1007/s11255-013-0500-5

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  • DOI: https://doi.org/10.1007/s11255-013-0500-5

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