title: Pulmonary congestion predicts cardiac events and mortality in ESRD.
abstract: Pulmonary congestion is highly prevalent and often asymptomatic among patients with ESRD treated with hemodialysis, but whether its presence predicts clinical outcomes is unknown. Here, we tested the prognostic value of extravascular lung water measured by a simple, well validated ultrasound B-lines score (BL-US) in a multicenter study that enrolled 392 hemodialysis patients. We detected moderate-to-severe lung congestion in 45% and very severe congestion in 14% of the patients. Among those patients with moderate-to-severe lung congestion, 71% were asymptomatic or presented slight symptoms of heart failure. Compared with those patients having mild or no congestion, patients with very severe congestion had a 4.2-fold risk of death (HR=4.20, 95% CI=2.45-7.23) and a 3.2-fold risk of cardiac events (HR=3.20, 95% CI=1.75-5.88) adjusted for NYHA class and other risk factors. Including the degree of pulmonary congestion in the model significantly improved the risk reclassification for cardiac events by 10% (P<0.015). In summary, lung ultrasound can detect asymptomatic pulmonary congestion in hemodialysis patients, and the resulting BL-US score is a strong, independent predictor of death and cardiac events in this population.
authors: National Research Council-Institute of Biomedicine, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy. carmine.zoccali@tin.it
authors: Carmine
authors: C
authors: Zoccali
authors: Claudia
authors: C
authors: Torino
authors: Rocco
authors: R
authors: Tripepi
authors: Giovanni
authors: G
authors: Tripepi
authors: Graziella
authors: G
authors: D'Arrigo
authors: Maurizio
authors: M
authors: Postorino
authors: Luna
authors: L
authors: Gargani
authors: Rosa
authors: R
authors: Sicari
authors: Eugenio
authors: E
authors: Picano
authors: Francesca
authors: F
authors: Mallamaci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015633:Extravascular Lung Water / Q000000981:diagnostic imaging*; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging*; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008168:Lung / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D006435:Renal Dialysis; D012307:Risk Factors; D016019:Survival Analysis; D014463:Ultrasonography