Kidney Institute of CPLA and Division of Nephrology, Changzheng Hospital, Naval Military Medical University, Shanghai, China.
Department of Nephrology, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China.
Ren Fail. 2022 Dec;44(1):1985-1992. doi: 10.1080/0886022X.2022.2132169.
Existed methods like biochemical markers improve the accuracy of fluid evaluation for the maintenance hemodialysis patients, but none of them has become the gold standard. This study aimed to evaluate the potential of lung ultrasonography as a useful tool for monitoring the volume status of the patients.
A total of 88 patients undergoing maintenance hemodialytic were enrolled in this prospective observational study. Patients were divided into three groups: overhydration (OH), normohydration, and hypohydration according to bioimpedance spectroscopy. Lung ultrasonography parameters, echocardiography parameters, and clinical characteristics of three groups were analyzed. After an average follow-up of 433 days, all-cause mortality among groups was compared.
The total number of lung comets was statistically reduced in patients after dialysis (= -6.891, < 0.001). This reduction was related to ΔOH (OH - Δ (the weight gain from dry weight)) and echocardiographic parameters, which proved the relationship among the comet-tail, hydration status of body and cardiac performance. The Kappa consistency test showed that lung ultrasonography and bioelectrical spectroscopy had moderate consistency. ROC analysis showed that the best cut-point of lung comet is 13. The pre-/post-dialysis lung comet-tail, cardiac function and total body impedance with all-cause mortality was investigated. Kaplan-Meier's analysis revealed that the all-cause mortality was higher in lung congestion patients.
This study proposes a potentially reliable lung ultrasonography method for estimating fluids overload, which also has implication value of all-cause mortality.
现有的生化标志物等方法提高了维持性血液透析患者液体评估的准确性，但没有一种方法成为金标准。本研究旨在评估肺部超声作为监测患者容量状态的有用工具的潜力。
本前瞻性观察研究共纳入 88 名接受维持性血液透析的患者。根据生物电阻抗光谱法将患者分为三组：水过多组（OH）、正常水合组和低血容量组。分析三组的肺部超声参数、超声心动图参数和临床特征。在平均随访 433 天后，比较各组的全因死亡率。
透析后患者的总彗星数统计学上减少（=-6.891，<0.001）。这种减少与ΔOH（OH-Δ（干体重增加量））和超声心动图参数有关，证明了彗星尾、身体和心脏性能的水化状态之间的关系。Kappa 一致性检验表明肺部超声和生物电阻抗光谱法具有中度一致性。ROC 分析显示，肺部彗星的最佳截断值为 13。分析了透析前后的肺彗星尾、心功能和全身阻抗与全因死亡率的关系。Kaplan-Meier 分析显示肺部充血患者的全因死亡率更高。
本研究提出了一种估计液体过载的潜在可靠的肺部超声方法，对全因死亡率也有一定的预测价值。
