Chest Ultrasound as a new tool for assessment of Volume Status in Hemodialysis Patients

Abstract

Objectives: The aim of this study was to assess volume changes in patients under haemodialysis by chest ultrasonography, inferior vena cava indices as well as clinical signs and correlate these findings with each other and with ultrafiltration volume. Patients and Methods: This prospective cohort study was done on 38 patients under regular hemodialysis in hemodialysis unit in Assiut university hospital. Pre and post dialysis volume status changes were assessed. Chest ultrasonography B lines score was used to assess extra volume lung water, IVC collapsing index was used to assess cardiovascular filling gradient and the 13 point clinical score to assess body hydration clinically. Correlation analysis between these findings and with ultrafiltration volume was done. Results: Statistically significant reduction in post dialysis chest ultrasonographic B-lines and the 13 point clinical score (Blood pressure- Respiratory rate – Heart failure score by NYHA class) was found (p value 0.000, p value 0.000) respectively. Moreover, reduction in overall Inferior vena cava indices (inspiratory-expiratory – collapsing index) was found but did not reach statistical significance (p value 0.185, p value 0.296, p value 0.194) respectively. On correlation analysis with ultrafiltration volume, only B lines score and heart failure as assessed by NYHA score had statistical significant correlation (p value 0.000, p value 0.000) respectively. Conclusions: Chest ultrasonography can be used to guide volume status management in patients under haemodialysis. Neither clinical signs nor Inferior vena cava indices can be used for assessment of volume status in these patients.