Abstract: SA-PO428
Comparison between Lung Ultrasonography and Clinical Assessment for Volume Control in Patients on Chronic Hemodialysis
Session Information
- Hemodialysis and Frequent Dialysis - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Author
- Kongpetch, Sawinee, Khon Kaen University, Nai Mueang, Khon Kaen, Thailand
Background
The management of volume overload to achieve dry weight improves hypertension and survival in hemodialysis patients. Several techniques are used for volume assessment, however, interventional studies with fluid-guided management are scarce. We aimed to compare between lung ultrasonography (LUS) and clinical assessment to guide volume reduction for blood pressure (BP) control.
Methods
The randomized control trial was conducted in chronic hemodialysis patients between December 2018 and March 2023. The study group was performed LUS every week for total 8 weeks to assess volume status and reduction of dry weight 0.05 and 0.1 kg/10-kg body weight if LUS score 16-30 and > 30, respectively. The control group was reduced dry weight as clinically indicated. Group-blindly investigators measured bioelectrical impedance analysis (BIA) in all participants at the start and finish times of study to assess the optimal dry weights and these results were concealed. At weeks 4 and 8, both groups were compared BP levels, dry weight achievement, cardiothoracic ratio evaluated by chest x-ray, number of antihypertensive drugs, N-terminal-pro-Brain Natriuretic Peptide (NT-proBNP) levels and intradialytic complications.
Results
A total of 83 patients with a mean age of 62.6±13 years and 72.5% male were randomized into the LUS group (n=41) and the clinical group (n=42). Baseline levels of the LUS vs. clinical groups were (a) systolic BP 146±17 vs. 143±11 mmHg, (b) cardiothoracic ratio 0.57±0.06 vs. 0.53±0.06, (c) median NT-proBNP 3,758 vs. 3,607 pg/mL. At weeks 4 and 8, systolic BP adjusted with baseline levels were significantly lower in the LUS groups (weeks 4; 134±13 vs.142±16, p <0.01 and weeks 8; 137±18 vs. 143±15, p=0.01). At the end of study, the LUS group also had (a) higher proportion of participants requiring less antihypertensive drugs (60% vs. 10%, p=0.002), (b) greater percentage of median cardiothoracic ratio reduction (-1.78% vs. 0.98%, p=0.03) and (c) closer levels of optimal dry weight obtained by BIA, than the clinical group. Incidences of intradialytic complications were similar in both groups.
Conclusion
LUS was helpful in volume assessment and fluid-guided management to achieve dry weight and control blood pressure. Further larger clinical trials should be conducted to prove benefit in survival of HD patients.
Funding
- Government Support – Non-U.S.