Pediatric department, Faculty of Medicine, Cairo University, 4 Extension of Nobar Street, Cairo, Egypt.
Pediatric department, National Research Center, Giza, Egypt.
Pediatr Nephrol. 2024 Oct;39(10):3057-3066. doi: 10.1007/s00467-024-06409-2. Epub 2024 Jun 6.
Accurate volume status assessment and dry weight achievement are the most challenging goals for a nephrologist. We aimed to evaluate the role of ultrasonographic parameters including lung ultrasound and inferior vena cava (IVC) measurements as practical methods of volume status assessment in children on hemodialysis by comparing them with established techniques, such as clinical evaluation and bioimpedance spectroscopy.
A prospective cross-sectional study compared pre- and post-dialysis volume status using bioimpedance spectroscopy (BIS) parameters and clinical data with ultrasonographic lung B-lines and IVC parameters in children on regular hemodialysis.
A total 60 children (mean age 9.4 ± 2.8 years) were enrolled. Twenty patients (33.3%) were clinically overloaded to varying degrees (17 patients had mild to moderate signs of fluid overload and 3 patients had moderate to severe signs of fluid overload). All other patients (66.7%) were clinically euvolemic. Sonographic parameters were significantly lower post-dialysis than pre-dialysis, including lung B-line count and IVC diameter. IVC collapsibility index mean was significantly higher post-dialysis than pre-dialysis. There was a significant correlation between the lung B-line count, IVC parameters, and BIS-measured overhydration both before and after hemodialysis. Nine patients had ≥ 8 B-lines post-dialysis, only three of them were hypertensive.
Clinical criteria alone are not specific for determining accurate fluid status in pediatric hemodialysis patients. Lung B-line score, IVC parameters, and BIS may be complementary to each other and to clinical data. Lung B-lines outperform IVC measurements and BIS in subclinical volume overload detection in pediatric hemodialysis patients.
准确评估容量状态和达到干体重是肾病医生面临的最大挑战。我们旨在通过与临床评估和生物电阻抗谱等既定技术进行比较，评估超声参数（包括肺部超声和下腔静脉（IVC）测量）在评估血液透析患儿容量状态方面的作用。
前瞻性横断面研究比较了常规血液透析患儿透析前后的容量状态，使用生物电阻抗谱（BIS）参数和临床数据与肺部超声 B 线和 IVC 参数。
共纳入 60 例患儿（平均年龄 9.4±2.8 岁）。20 例（33.3%）患者存在不同程度的临床超负荷（17 例存在轻至中度液体超负荷征象，3 例存在中至重度液体超负荷征象）。其余所有患者（66.7%）均为临床正常容量。与透析前相比，透析后超声参数（肺部 B 线计数和 IVC 直径）明显降低，IVC 塌陷指数明显升高。透析前后肺部 B 线计数、IVC 参数与 BIS 测量的超水量均有显著相关性。9 例患儿透析后 B 线数≥8 条，其中仅 3 例为高血压。
仅凭临床标准无法准确确定儿科血液透析患者的液体状态。肺部 B 线评分、IVC 参数和 BIS 可能相互补充，也可能与临床数据互补。肺部 B 线在儿科血液透析患者亚临床容量超负荷检测中优于 IVC 测量和 BIS。
