Quantitative Lung Ultrasonography for the Nephrologist: Applications in Dialysis and Heart Failure. Kidney360 2022 Jan 27;3(1):176-184
Date
04/05/2022Pubmed ID
35368560Pubmed Central ID
PMC8967614DOI
10.34067/KID.0003972021Scopus ID
2-s2.0-85138954341 (requires institutional sign-in at Scopus site) 10 CitationsAbstract
Volume overload, and its attendant increase in acute care utilization and cardiovascular morbidity and mortality, represents a critical challenge for the practicing nephrologist. This is particularly true among patients with ESKD on HD, where predialysis volume overload and intradialytic and postdialytic hypovolemia account for almost a third of all cost for the Medicare dialysis benefit. Quantitative lung ultrasound is a tool for assessing the extent of extravascular lung water that outperforms physical exam and plain chest radiography. B-lines are vertical hyperechoic artifacts present in patients with increased extravascular lung water. B-lines have been shown to decrease dynamically during the hemodialysis treatment in proportion to ultrafiltration volume. Among patients with chronic heart failure, titration of diuretics on the basis of the extent of pulmonary congestion noted on lung ultrasonography has been shown to decrease recurrent acute care utilization. Early data from randomized controlled trials of lung ultrasound-guided ultrafiltration therapy among patients with ESKD on HD have shown promise for potential reduction in recurrent episodes of decompensated heart failure and cardiovascular events. Ultimately, lung ultrasound may predict those who are ultrafiltration tolerant and could be used to decrease acute care utilization and, thus, cost in this population.
Author List
Reisinger N, Koratala AAuthor
Abhilash Koratala MD Associate Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedHeart Failure
Humans
Lung
Medicare
Nephrologists
Renal Dialysis
Ultrasonography
United States
