Nephrology Department, Brugmann University Hospital, Université libre de Bruxelles, 4 place Van Gehuchten, 1020 Brussels, Belgium.
Laboratory of Experimental Nephrology, Faculty of Medicine, Université libre de Bruxelles, Erasme Campus, 808 route de Lennik, 1070 Brussels, Belgium.
Int J Mol Sci. 2024 Oct 19;25(20):11263. doi: 10.3390/ijms252011263.
Pulmonary congestion (PC) is common in hemodialysis (HD) patients. We explored the association of anemia and pulmonary congestion in HD patients. A prospective pilot observational study included 18 patients on maintenance HD. Individual B-lines scores (BLS; 8-sites method) were obtained by lung ultrasound, before and after the first two consecutive HD sessions of the week (HD1-HD2), with different inter-dialytic intervals (68 vs. 44 h). Bioimpedance spectroscopy body composition (BIS) was performed before each HD session. Hemoglobin (Hb) levels, in addition to circulating markers of chronic inflammation (soluble urokinase Plasminogen Activator Receptor [suPAR], soluble Suppression of Tumorigenicity 2 [sST2]) were obtained. Mean (±SD) BLS values were quite elevated at all time points: Pre-HD1 (16 ± 5.53), post-HD1 (15.3 ± 6.63), pre-HD2 (16.3 ± 5.26) and post-HD2 (13.6 ± 5.83), respectively. No direct significant correlation was found between inflammation markers levels and BLS. However, mean levels (±SD, ng/mL) of suPAR pre-HD1 (7.88 ± 3.07) and pre-HD2 (7.78 ± 3.02) remained significantly above the normal range (<4 ng/mL), and sST2 levels reached 2-fold the upper normal value in most patients (27.4 ± 17.8). Pulmonary congestion reflected by BLS was negatively correlated to Hb levels pre-HD1 (R² = 0.439, = 0.003), and pre-HD2 (R² = 0.301, = 0.018). In addition, Hb levels were negatively correlated to global volume status estimated by BIS (R² = 0.351, = 0.009). Hemoglobin levels were negatively correlated to pulmonary congestion and to the global volume status evaluated by BIS. Chronic inflammation markers were increased in HD patients, suggesting a complex volume- and non-volume-dependent pathophysiology of pulmonary congestion in HD patients.
肺淤血（PC）在血液透析（HD）患者中很常见。我们探讨了贫血与 HD 患者肺淤血的关系。一项前瞻性试点观察性研究纳入了 18 名维持性 HD 患者。在每周的前两次连续 HD 治疗（HD1-HD2）前后，通过肺部超声获得个体 B 线评分（BLS；8 点法），两次 HD 之间的间歇时间不同（68 小时与 44 小时）。在每次 HD 治疗前进行生物电阻抗光谱身体成分（BIS）检测。获得血红蛋白（Hb）水平，以及循环慢性炎症标志物（可溶性尿激酶型纤溶酶原激活物受体 [suPAR]、可溶性抑瘤素 2 [sST2]）。所有时间点的 BLS 值均较高：HD1 前（16 ± 5.53）、HD1 后（15.3 ± 6.63）、HD2 前（16.3 ± 5.26）和 HD2 后（13.6 ± 5.83）。炎症标志物水平与 BLS 之间无直接显著相关性。然而，HD1 前（7.88 ± 3.07）和 HD2 前（7.78 ± 3.02）suPAR 的平均水平（±SD，ng/mL）仍显著高于正常范围（<4ng/mL），sST2 水平在大多数患者中达到正常上限的 2 倍（27.4 ± 17.8）。BLS 反映的肺淤血与 HD1 前的 Hb 水平呈负相关（R²=0.439， =0.003），与 HD2 前的 Hb 水平呈负相关（R²=0.301， =0.018）。此外，Hb 水平与 BIS 评估的总体容量状态呈负相关（R²=0.351， =0.009）。Hb 水平与肺淤血和 BIS 评估的总体容量状态呈负相关。HD 患者的慢性炎症标志物增加，提示 HD 患者肺淤血存在复杂的容量和非容量依赖性病理生理学。
