Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China.
Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
Int J Clin Pract. 2024 Jan 9;2024:1232211. doi: 10.1155/2024/1232211. eCollection 2024.
Volume overload is a fatal complication for people undergoing hemodialysis. Therefore, regulating a patient's "dry weight" based on their fluid status is imperative. Clinical experiences are too subjective to accurately judge a patient's fluid status, but techniques have emerged for improved fluid control in the two decades. Specifically, lung ultrasonography (LUS) uses a unique aspect of ultrasound images, the B-lines, to evaluate extravascular lung water, which has increasingly attracted attention. However, the role of B-line quantification in predicting short-mid-term death and/or cardiovascular complications is unclear.
Patients undergoing MHD at the hemodialysis center of Zhejiang Provincial People's Hospital from October 1, 2020, to February 28, 2021, were examined using LUS and a bioelectrical impedance analysis before and after dialysis, and related clinical data were collected. All patients were followed up for one year after the examination, and deaths and first cardiovascular events (e.g., stroke, myocardial infarction, and heart failure) during this period were recorded.
98 patients were enrolled and divided into three groups in relation to their mild (<16 B-lines), moderate (16-30 B-lines), or severe (>30 B-lines) hypervolemia, defined by the number of B-lines. The long-term survival rate was significantly lower in the severe group than in the mild and moderate groups. LUS and bioelectrical impedance-related parameters (e.g., extracellular water-to-water ratio) were closely related to cardiac ultrasound parameters (left ventricular ejection fraction) ( < 0.001). The optimal B-line cutoff value on LUS for predicting fluid overload (defined clinically) in patients on hemodialysis was 11.5 lines (AUC = 0.840, 95% confidence interval 0.735-0.945, < 0.001), and the diagnostic sensitivity and specificity were both 76.5%. During the one-year follow-up period, ten deaths and six cardiovascular events occurred. The survival rate was significantly lower in the severe group than in the mild group (log-rank test = 10.050, =0.002) but did not differ between the severe and moderate groups ( = 2.629, =0.105).
LUS is a cheap, noninvasive, simple, and repeatable volume-monitoring method that can assist with individualized fluid volume management in patients undergoing MHD. LUS results may also help to predict the short-mid-term survival rate of patients to a certain extent.
容量超负荷是血液透析患者的致命并发症。因此，根据患者的液体状况调整“干体重”至关重要。临床经验过于主观，无法准确判断患者的液体状况，但在过去二十年中出现了一些技术来改善液体控制。具体来说，肺部超声（LUS）使用超声图像的一个独特方面，即 B 线，来评估血管外肺水，这越来越受到关注。然而，B 线定量在预测短期至中期死亡和/或心血管并发症中的作用尚不清楚。
2020 年 10 月 1 日至 2021 年 2 月 28 日，在浙江省人民医院血液透析中心接受 MHD 的患者在透析前后接受 LUS 和生物电阻抗分析检查，并收集相关临床数据。所有患者在检查后随访一年，记录在此期间的死亡和首次心血管事件（如中风、心肌梗死和心力衰竭）。
共纳入 98 例患者，根据 B 线数量将其分为轻度（<16 条 B 线）、中度（16-30 条 B 线）或重度（>30 条 B 线）高容量组。重度组的长期生存率明显低于轻度和中度组。LUS 和生物电阻抗相关参数（如细胞外水与水的比值）与心脏超声参数（左心室射血分数）密切相关（<0.001）。LUS 预测血液透析患者临床定义的液体超负荷的最佳 B 线截断值为 11.5 条（AUC=0.840，95%置信区间 0.735-0.945，<0.001），诊断的灵敏度和特异性均为 76.5%。在一年的随访期间，发生了 10 例死亡和 6 例心血管事件。重度组的生存率明显低于轻度组（对数秩检验=10.050，=0.002），但重度组与中度组之间无差异（=2.629，=0.105）。
LUS 是一种廉价、无创、简单且可重复的容量监测方法，可辅助血液透析患者进行个体化液体容量管理。LUS 结果在一定程度上还可以帮助预测患者的短期至中期生存率。
