Faculty of Medicine, Division of Pediatric Intensive Care Unit, Çukurova University, Sarıçam, Adana, Turkey.
Faculty of Medicine, Division of Pediatric Nephrology, Çukurova University, Sarıçam, Adana, Turkey.
Eur J Pediatr. 2021 Oct;180(10):3191-3200. doi: 10.1007/s00431-021-04086-z. Epub 2021 Apr 30.
Although the number of studies evaluating methods to predict fluid overload is increasing, the assessment of fluid status in children on dialysis is still fraught with inaccuracies. We aimed to evaluate the predictive capability of lung ultrasounds and the inferior vena cava collapsibility index (cIVC) in predialysis overhydration in children with end-stage kidney disease. Ten children with end-stage kidney disease who were on an intermittent hemodialysis program were included. The hydration status of the patients was clinically evaluated. Moreover, 30 predialysis and 30 postdialysis lung ultrasound, cIVC, and bioimpedance spectroscopy (BIS) measurements were performed. The median age of the participants was 14 (IQR, 13-15) years, and two (20%) were male. There was a strong positive correlation between the predialysis total number of B-lines and predialysis fluid overload (r=0.764, p<0.001). Additionally, there was a moderate negative correlation between predialysis cIVC and predialysis fluid overload (r=-0.599, p=0.002). Although the moderate correlation was determined between the postdialysis fluid overload and total number of B-lines, no correlation was determined using cIVC. Receiver operating characteristic curves demonstrated that the total number of B-lines and cIVC could successfully predict the predialysis fluid overload (relative hydration >7% derived from the BIS; AUROC 0.82 and 0.80, respectively). When both evaluations were combined, if either the total number of B-lines or the cIVC was outside the corresponding cutoff range (>10.5 and ≤23.5, respectively), it was detected in 16 out of 17 sessions (sensitivity 94%). If either one was outside the corresponding cutoff range (total number of B-lines >10.5 and cIVC ≤18.2), the severe predialysis fluid overload was predicted successfully in all eight (100%) sessions. Conclusion: Randomized controlled studies are needed to prove the reliability of the combined use of lung ultrasounds and cIVC in the assessment of predialysis fluid overload. What is Known: • The association of chronic fluid overload with increased morbidity and mortality raises the need for optimal determination of fluid overload in pediatric patients who are dialysis-dependent at a young age. • The linear correlation between the total number of B-lines on lung ultrasound images and fluid overload by weight has been shown. What is New: • This study evaluates the lung ultrasound and inferior vena cava collapsibility index combined in predicting fluid overload in dialytic children. • If either the total number of B-lines or the cIVC was outside the corresponding cutoff range (>10.5 and cIVC ≤18.2, respectively), the severe predialysis fluid overload was predicted successfully in all eight (100%) sessions.
虽然评估预测液体超负荷方法的研究数量正在增加，但儿童透析患者液体状态的评估仍然存在不准确的情况。我们旨在评估肺超声和下腔静脉塌陷指数（cIVC）在预测终末期肾病儿童透析前液体超负荷中的预测能力。纳入了 10 名接受间歇性血液透析的终末期肾病儿童。临床评估了患者的液体状态。此外，还进行了 30 次透析前和 30 次透析后肺超声、cIVC 和生物阻抗谱（BIS）测量。参与者的中位年龄为 14 岁（IQR，13-15 岁），其中 2 名（20%）为男性。透析前总 B 线数与透析前液体超负荷呈强正相关（r=0.764，p<0.001）。此外，透析前 cIVC 与透析前液体超负荷呈中度负相关（r=-0.599，p=0.002）。尽管透析后液体超负荷与总 B 线数之间存在中度相关性，但 cIVC 之间没有相关性。受试者工作特征曲线表明，总 B 线数和 cIVC 可以成功预测透析前液体超负荷（BIS 得出的相对水合度>7%；AUROC 分别为 0.82 和 0.80）。当联合评估时，如果总 B 线数或 cIVC 超出相应的截断范围（>10.5 和≤23.5），则在 17 次透析中的 16 次中（敏感性 94%）检测到。如果两者均超出相应的截断范围（总 B 线数>10.5 和 cIVC≤18.2），则在所有 8 次（100%）透析中成功预测严重的透析前液体超负荷。结论：需要进行随机对照研究，以证明肺超声和 cIVC 联合评估在评估透析前液体超负荷中的可靠性。已知内容：• 慢性液体超负荷与发病率和死亡率增加有关，这就需要在年幼时依赖透析的儿科患者中最佳确定液体超负荷。• 已经显示肺超声图像上总 B 线数与体重相关的液体超负荷之间存在线性关系。新内容：• 本研究评估了肺超声和下腔静脉塌陷指数联合预测透析儿童液体超负荷的情况。• 如果总 B 线数或 cIVC 超出相应的截断范围（分别为>10.5 和 cIVC≤18.2），则在所有 8 次（100%）透析中成功预测严重的透析前液体超负荷。
