title: The Agreement between Auscultation and Lung Ultrasound in Hemodialysis Patients: The LUST Study.
abstract: Accumulation of fluid in the lung is the most concerning sequela of volume expansion in patients with ESRD. Lung auscultation is recommended to detect and monitor pulmonary congestion, but its reliability in ESRD is unknown.
  
  
  
  In a subproject of the ongoing Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, we compared a lung ultrasound-guided ultrafiltration prescription policy versus standard care in high-risk patients on hemodialysis. The reliability of peripheral edema was tested as well. This study was on the basis of 1106 pre- and postdialysis lung ultrasound studies (in 79 patients) simultaneous with standardized lung auscultation (crackles at the lung bases) and quantification of peripheral edema.
  
  
  
  Lung congestion by crackles, edema, or a combination thereof poorly reflected the severity of congestion as detected by ultrasound B lines in various analyses, including standard regression analysis weighting for repeated measures in individual patients (shared variance of 12% and 4% for crackles and edema, respectively) and κ-statistics (κ ranging from 0.00 to 0.16). In general, auscultation had very low discriminatory power for the diagnosis of mild (area under the receiver operating curve =0.61), moderate (area under the receiver operating curve =0.65), and severe (area under the receiver operating curve =0.68) lung congestion, and the same was true for peripheral edema (receiver operating curve =0.56 or lower) and the combination of the two physical signs.
  
  
  
  Lung crackles, either alone or combined with peripheral edema, very poorly reflect interstitial lung edema in patients with ESRD. These findings reinforce the rationale underlying the Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, a trial adopting ultrasound B lines as an instrument to guide interventions aimed at mitigating lung congestion in high-risk patients on hemodialysis.
authors.affiliation: Due to the number of contributing authors, the affiliations are provided in the Supplemental Material .
authors.forename: Claudia
authors.initials: C
authors.lastname: Torino
authors.forename: Luna
authors.initials: L
authors.lastname: Gargani
authors.forename: Rosa
authors.initials: R
authors.lastname: Sicari
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Letachowicz
authors.forename: Robert
authors.initials: R
authors.lastname: Ekart
authors.forename: Danilo
authors.initials: D
authors.lastname: Fliser
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.forename: Kostas
authors.initials: K
authors.lastname: Siamopoulos
authors.forename: Aristeidis
authors.initials: A
authors.lastname: Stavroulopoulos
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Massy
authors.forename: Enrico
authors.initials: E
authors.lastname: Fiaccadori
authors.forename: Alberto
authors.initials: A
authors.lastname: Caiazza
authors.forename: Thomas
authors.initials: T
authors.lastname: Bachelet
authors.forename: Itzchak
authors.initials: I
authors.lastname: Slotki
authors.forename: Alberto
authors.initials: A
authors.lastname: Martinez-Castelao
authors.forename: Marie-Jeanne
authors.initials: MJ
authors.lastname: Coudert-Krier
authors.forename: Patrick
authors.initials: P
authors.lastname: Rossignol
authors.forename: Faikah
authors.initials: F
authors.lastname: Gueler
authors.forename: Thierry
authors.initials: T
authors.lastname: Hannedouche
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Panichi
authors.forename: Andrzej
authors.initials: A
authors.lastname: Wiecek
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pontoriero
authors.forename: Pantelis
authors.initials: P
authors.lastname: Sarafidis
authors.forename: Marian
authors.initials: M
authors.lastname: Klinger
authors.forename: Radovan
authors.initials: R
authors.lastname: Hojs
authors.forename: Sarah
authors.initials: S
authors.lastname: Seiler-Mussler
authors.forename: Fabio
authors.initials: F
authors.lastname: Lizzi
authors.forename: Dimitrie
authors.initials: D
authors.lastname: Siriopol
authors.forename: Olga
authors.initials: O
authors.lastname: Balafa
authors.forename: Linda
authors.initials: L
authors.lastname: Shavit
authors.forename: Rocco
authors.initials: R
authors.lastname: Tripepi
authors.forename: Francesca
authors.initials: F
authors.lastname: Mallamaci
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
authors.forename: Gérard Michel
authors.initials: GM
authors.lastname: London
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001314:Auscultation; D004487:Edema / Q000150:complications*; D005121:Extremities; D005260:Female; D017583:Hemodiafiltration; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D012372:ROC Curve; D006435:Renal Dialysis; D012135:Respiratory Sounds; D012720:Severity of Illness Index; D014463:Ultrasonography
keywords: Auscultation; Cardiomyopathies; Edema; Humans; Kidney Failure, Chronic; Pulmonary Edema; Regression Analysis; Reproducibility of Results; Respiratory Sounds; Sound; Water; chronic kidney disease; clinical epidemiology; end-stage renal disease; hemodialysis; renal dialysis; ultrafiltration