title: Chest ultrasound and hidden lung congestion in peritoneal dialysis patients.
abstract: BACKGROUND
  Chest ultrasound (US) is a non-invasive well-validated technique for estimating extravascular lung water (LW) in patients with heart diseases and in end-stage renal disease. We systematically applied this technique to the whole peritoneal dialysis (PD) population of five dialysis units.
  
  
  METHODS
  We studied the cross-sectional association between LW, echocardiographic parameters, clinical [pedal oedema, New York Heart Association (NYHA) class] and bioelectrical impedance analysis (BIA) markers of volume status in 88 PD patients.
  
  
  RESULTS
  Moderate to severe lung congestion was evident in 41 (46%) patients. Ejection fraction was the echocardiographic parameter with the strongest independent association with LW (r = -0.40 P = 0.002). Oedema did not associate with LW on univariate and multivariate analysis. NYHA class was slightly associated with LW (r = 0.21 P = 0.05). Among patients with severe lung congestion, only 27% had pedal oedema and the majority (57%) had no dyspnoea (NYHA Class I). Similarly, the prevalence of patients with BIA, evidence of volume excess was small (11%) and not significantly different (P = 0.79) from that observed in patients with mild or no congestion (9%).
  
  
  CONCLUSIONS
  In PD patients, LW by chest US reveals moderate to severe lung congestion in a significant proportion of asymptomatic patients. Intervention studies are necessary to prove the usefulness of chest US for optimizing the control of fluid excess in PD patients.
authors.affiliation: Nephrology, Dialysis, Hypertension and Renal Transplantation Unit, Ospedali Riuniti, Reggio Calabria, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Panuccio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Enia
authors.forename: Rocco
authors.initials: R
authors.lastname: Tripepi
authors.forename: Claudia
authors.initials: C
authors.lastname: Torino
authors.forename: Maurizio
authors.initials: M
authors.lastname: Garozzo
authors.forename: Giovanni Giorgio
authors.initials: GG
authors.lastname: Battaglia
authors.forename: Carmelita
authors.initials: C
authors.lastname: Marcantoni
authors.forename: Lorena
authors.initials: L
authors.lastname: Infantone
authors.forename: Guido
authors.initials: G
authors.lastname: Giordano
authors.forename: Maria Loreta
authors.initials: ML
authors.lastname: De Giorgi
authors.forename: Mario
authors.initials: M
authors.lastname: Lupia
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Bruzzese
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000032:analysis; D003430:Cross-Sectional Studies; D004452:Echocardiography; D017097:Electric Impedance; D015633:Extravascular Lung Water / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D011379:Prognosis; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology*; D012307:Risk Factors; D013909:Thorax / Q000000981:diagnostic imaging*
chemical_list: D015415:Biomarkers