B7(T)
ASSESSMENT OF EXTRA VASCULAR LUNG WATER IN PATIENTS
ON HAEMODIALYSIS
Jujjavarapu, S1, McIntyre, C1,2.
1
Renal Medicine, Royal Derby Hospital, Derby 2University of Nottingham, Derby
BACKGROUND: Cardiac dysfunction and LVH are common in dialysis patients and are strong
adverse prognostic factors. Hypertension and fluid overload are likely to be major factors in their
development. Appropriate selection of desired target weight (TW) remains a critical therapeutic target
in HD patient management, but this represents a considerable challenge with current methods of
assessment. Ultrasound assessment of the chest and the detection of lung comets (echogenic shadows
which are lung wall based) have been shown to correlate with extra vascular lung water (EVLW). The
aim of this study is to assess the use of this technique to investigate the presence of EVLW in HD
patients with an ideal TW already set on the basis of usual clinical practise.
METHOD: A total of 11 patients undergoing haemodialysis had ultrasound examination of chest
twice (pre and post dialysis) from second to fourth intercostal space on left side ( to fifth intercostal
space on right side) and the total ultrasound lung comet (ULC) score obtained by adding the number
of comets in 28 spaces. Standard description of patient characteristics and dialysis based factors were
also recorded.
RESULTS: At the beginning of the dialysis patients 8/11 patients had detectable comets, indicative
of significant EVLW. Only 3 patients did not show any comets. The number of comets at the
beginning of the session ranged from 0 to 22. Dialysis significantly reduced the number of lung
comets (p=0.01); the number of comets post dialysis ranged from 0 to 14. 5 patients showed no
detectable comets after dialysis and 6 patients still had EVLW at the end of dialysis having achieved
their target weight. The procedure was well tolerated by all patients. Each session to detect lung
comets took around 10 minutes.
CONCLUSION: Significant EVLW was detectable in the majority of patients pre dialysis and
significantly reduced after ultra filtration to previously determined TW. Chest ultrasound is non
invasive, less time consuming and can be performed by most of the clinical staff with suitable training
and has the potential to be a promising tool in the setting and achievement of appropriate euvolaemia
in HD patients. EVLW assessment appears to warrant further prospective evaluation in this clinical
context.