Kidney Week

Abstract: TH-OR11

Role of the Pre-Hemodialysis Lung Ultrasound for Dry-Weight Assessment and Intradialytic Hypotension Risk Prediction

Session Information

• Dialysis: Patient-Centered Interventions and Outcomes
  November 03, 2022 | Location: W414, Orange County Convention Center‚ West Building
  Abstract Time: 04:30 PM - 04:39 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Palazzini, Giulia, Universita degli Studi di Firenze, Firenze, Toscana, Italy

Giulia Palazzini, MD

• Lugli, Gianmarco, Universita degli Studi di Firenze, Firenze, Toscana, Italy

Gianmarco Lugli,

• Gianassi, Iacopo, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy

Iacopo Gianassi,

• Dervishi, Egrina, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy

Egrina Dervishi,

• Cirami, Lino Calouero, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy

Lino Calouero Cirami,

• Allinovi, Marco, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy

Marco Allinovi,

Background

Intradialytic hypotension (IDH) is a frequent complication of hemodialysis, occurring in about one-third of patients. The importance of IDH is given by its association with potential severe clinical outcomes. Nevertheless, IDH prediction and dry-weight determination may be difficult by using conventional parameters and techniques.

Methods

In this prospective observational study, 91 chronic hemodialytic patients underwent a multiparametric evaluation of fluid status, through lung ultrasound (LUS) with quantification of B-lines, physical examination, blood pressure, NT-proBNP and chest X-rays, immediately before and at the end of the dialysis session. The patients were divided into IDH or no-IDH group.

Results

A pre-dialysis B-line number ≥15 showed a high sensitivity in fluid overload diagnosis (90%), even higher than chest X-ray and physical examination. On the other hand, a pre-dialysis number of B-lines ≤8 was predictive of IDH episode with a sensibility of 61.7% and a specificity of 74.2% (ROC curve was 0.704). A single increase in B-lines number gave a 5.083 times higher odds to exhibit fluid overload and a 0.957 times higher odds to exhibit IDH, thus indicating that decreasing B-lines was associated with an increasing likelihood of IDH. At the multivariable analysis, NYHA class, blood-albumin low level, low pre-dialysis systolic BP and a low pre-dialysis B-line number resulted as independent risk factors for IDH.

Conclusion

LUS is a valuable and reliable method for evaluating fluid status in dialysis patients. B-lines quantification at the beginning of dialysis showed a high sensitivity in fluid overload diagnosis and IDH prediction. Thus, LUS can help individualized ultrafiltrative profile prescription through an integrated bedside approach.

Multivariable analysis on different risk factors for predicting an intradialytic hypotension episode