Zoccali Carmine
CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases, Ospedali Riuniti, Reggio, Calabria, Italy.
Semin Dial. 2017 Jan;30(1):6-9. doi: 10.1111/sdi.12559. Epub 2016 Nov 6.
Volume overload is a hidden, pervasive complication in dialysis patients with dyspnea and pulmonary edema being its main clinical manifestations. Measuring lung water has clinical potential because it allows timely treatment of lung congestion at a preclinical stage. Chest ultrasound (US) is a novel, well-validated technique that allows reliable estimates of lung water in clinical practice. The application of this technique in dialysis patients has shown that an unsuspectedly high proportion of these patients have moderate to severe lung congestion which is usually asymptomatic. Furthermore, lung congestion in these patients is only loosely associated with fluid excess as measured by bioimpedance (BIA). Lung congestion is associated with a high death risk in dialysis patients and therefore represents a potential treatment target. The "Lung water by Ultra-Sound guided Treatment to prevent death and cardiovascular complications in high risk ESRD patients with cardiomyopathy" (LUST) study will provide important information about the clinical value of this technique in the care of hemodialysis patients at high cardiovascular risk.
容量超负荷是透析患者中一种隐匿且普遍存在的并发症，呼吸困难和肺水肿是其主要临床表现。测量肺水具有临床应用潜力，因为它能在临床前期及时治疗肺淤血。胸部超声（US）是一种新型且经过充分验证的技术，可在临床实践中可靠地估算肺水。该技术在透析患者中的应用表明，这些患者中未被怀疑的高比例存在中度至重度肺淤血，且通常无症状。此外，通过生物阻抗（BIA）测量，这些患者的肺淤血与液体过多仅有松散关联。肺淤血与透析患者的高死亡风险相关，因此是一个潜在的治疗靶点。“超声引导下治疗肺水以预防高危终末期肾病合并心肌病患者死亡和心血管并发症”（LUST）研究将提供有关该技术在心血管高危血液透析患者护理中的临床价值的重要信息。
