Abstract: SA-PO905
Diagnostic Performance of Lung Ultrasound and a Clinical Score for the Evaluation of Hydration Status in Hemodialysis Patients
Session Information
- Dialysis: Cardiovascular, BP, Volume
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Bobot, Mickaël, Aix-Marseille University, Marseille, France
- Jourde-Chiche, Noemie, Aix-Marseille University, Marseille, France
- Sallée, Marion, Aix-Marseille University, Marseille, France
- Dussol, Bertrand, Aix-Marseille University, Marseille, France
- Berland, Yvon, Service de Nephrologie CHU Conception Marseille, Marseille, France
- Robert, Thomas, Service de Nephrologie CHU Conception Marseille, Marseille, France
Background
Estimating the hydration status of the hemodialysis patients is a key point in their management. So far, there is no gold standard feasible in daily routine. We performed a prospective study in chronic hemodialysis patients to evaluate the diagnostic performance of lung ultrasound and clinical examination for the evaluation of fluid overload using transthoracic echocardiography (TTE) as gold standard.
Methods
31 patients performing chronic hemodialysis for more than 3 months in a dialysis center were included. Patients with pulmonary fibrosis were not included. The hydration status was assessed weekly by: a clinical score (Major criteria: dyspnea NYHA> III, orthopnea, minor criteria: jugular turgor (JT), hepatic jugular reflux (HJR), pulmonary crackles, peripheral edema and pre-dialysis hypertension); a TTE score (inferior vena cava diameter, E / E’ ratio and systolic pulmonary arterial pressures); and Echo-comet score by lung ultrasound (sum of anterior and lateral B-lines in 28 chest areas).
Results
5 patients had a TTE fluid overload. Compared with TTE, the diagnostic performance of the clinical score was: a sensitivity (Se) of 100%, a specificity (Sp) of 81%, a positive predictive value (PPV) of 50% and a negative predictive value (NPV) of 100%. Only orthopnea (p = 0.008), JT (p = 0.005) and HJR (p = 0.008) were significantly associated with TTE fluid overload diagnosis. The diagnostic performance of Echo-comet score by lung ultrasound has a Se of 80%, a Sp of 59%, a PPV of 26% and a NPV of 94%. 10 patients (32.3%) had an increase of extravascular lung water without evidence fluid overload with TTE or clinical score.
Conclusion
This is the first study that defines a clinical score to assess fluid overload in hemodialysis patients. This clinical score has a satisfying diagnostic performance compared to TTE and would be easily used in daily clinical routine to adjust dry weight. Fluid overload evaluation using the echo-comet score by lung ultrasound seems poorly correlated with the fluid overload evaluated by TTE score. Noteworthy, asymptomatic pulmonary congestion was detected with lung ultrasound without fluid overload according the clinical and TTE score. This particular patient group need further investigation to determine a diagnostic and prognostic significance.