title: Detection of pulmonary congestion by chest ultrasound in dialysis patients.
abstract: OBJECTIVE
  This study sought to investigate clinical and echocardiographic correlates of the lung comets score.
  
  
  BACKGROUND
  Early detection of pulmonary congestion is a fundamental goal for the prevention of congestive heart failure in high-risk patients.
  
  
  METHODS
  We undertook an inclusive survey by a validated ultrasound (US) technique in a hemodialysis center to estimate the prevalence of pulmonary congestion and its reversibility after dialysis in a population of 75 hemodialysis patients.
  
  
  RESULTS
  Chest US examinations were successfully completed in all patients (N = 75). Before dialysis, 47 patients (63%) exhibited moderate to severe lung congestion. This alteration was commonly observed in patients with heart failure but also in the majority of asymptomatic (32 of 56, 57%) and normohydrated (19 of 38, 50%) patients. Lung water excess was unrelated with hydration status but it was strongly associated with New York Heart Association functional class (p < 0.0001), left ventricular ejection fraction (r = -0.55, p < 0.001), early filling to early diastolic mitral annular velocity (r = 0.48, p < 0.001), left atrial volume (r = 0.39, p = 0.001), and pulmonary pressure (r = 0.36, p = 0.002). Lung water reduced after dialysis, but 23 patients (31%) still had pulmonary congestion of moderate to severe degree. Lung water after dialysis maintained a strong association with left ventricular ejection fraction (r = -0.59, p < 0.001), left atrial volume (r = 0.30, p = 0.01), and pulmonary pressure (r = 0.32, p = 0.006) denoting the critical role of cardiac performance in the control of this water compartment in end-stage renal disease. In a multiple regression model including traditional and nontraditional risk factors only left ventricular ejection fraction maintained an independent link with lung water excess (beta = -0.61, p < 0.001). Repeatability studies of the chest US technique (Bland-Altman plots) showed good interobserver and inter-US probes reproducibility.
  
  
  CONCLUSIONS
  Pulmonary congestion is highly prevalent in symptomatic (New York Heart Association functional class III to IV) and asymptomatic dialysis patients. Chest ultrasound is a reliable technique that detects pulmonary congestion at a pre-clinical stage in end-stage renal disease.
authors.affiliation: Nephrology and Renal Transplantation Unit Ospedali Riuniti, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mallamaci
authors.forename: Francesco A
authors.initials: FA
authors.lastname: Benedetto
authors.forename: Rocco
authors.initials: R
authors.lastname: Tripepi
authors.forename: Stefania
authors.initials: S
authors.lastname: Rastelli
authors.forename: Pietro
authors.initials: P
authors.lastname: Castellino
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015633:Extravascular Lung Water / Q000000981:diagnostic imaging*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000453:epidemiology; D006439:Hemodynamics; D006801:Humans; D007558:Italy; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015995:Prevalence; D011654:Pulmonary Edema / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D012044:Regression Analysis; D006435:Renal Dialysis; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014463:Ultrasonography; D014882:Water-Electrolyte Balance