Assessment of Volume Status of Hemodialysis Patients using Sonographic Lung Comets
Background: Fluid balance is important in patients with renal impairment and undergoing hemodialysis. ‘‘Dry’’ weight is usually assessed clinically, and also, bioimpedance is considered reliable. The use of chest ultrasound to detect lung water received growing attention in clinical research in intensive care patients and in patients with heart failure. Recently ultrasonographic lung comets (counting B-lines artifact) evaluates extravascular lung water while ultrasonography of inferior vena cava (IVC) estimates central venous pressure, so ultrasound is considered as a useful tool to evaluate the hydration status of hemodialysis patients. Objectives: The study was designed to use lung ultrasound to assess lung congestion before and after a dialysis session in correlation to clinical signs and symptoms and the achieved dry weight in end stage renal disease patients on maintenance hemodialysis. Methods: The present study included 25 patients on maintenance hemodialysis in Alexandria University Hospitals. All the patients were subjected to thorough history taking with special concern on grade of dyspnea and ultrafiltration volume, as well as full clinical examination before and after dialysis including vital signs and signs of hypervolemia as congested neck veins, fine basal crepitations, congested liver and lower limb edema. Radiological examination including ultrasound lung comets score and diameter of hepatic portion of inferior vena cava (IVC) before and after dialysis session. Results: The mean lung comets score before dialysis was high and decreased significantly after dialysis. There was a significant positive correlation between ultrafiltration volume and the absolute change of lung comets score while there was no correlation between the ultrafiltration volume and the absolute change of IVC diameter. There was a significant correlation between lung comets score and grade of dyspnea before dialysis as well as after dialysis. There was a significant positi
