#2880 ASSESSMENT OF FLUID STATUS BY COMBINATION OF LUNG ULTRASOUND, BIOIMPEDANCE, AND INFERIOR VENA CAVA MEASUREMENT IN HEMODIALYSIS PATIENTS

Abstract

Abstract Background and Aims Assessment of fluid status in hemodialysis patients (HD) remains a major challenge for nephrologists. Fluid overload is one of the most common modifiable risk factors directly associated with hypertension. The purpose of our study was to investigate whether the combination of three bedside methods-lung ultrasound comets (LUC), multifrequency bioimpedance (MBIS), and inferior vena cava diameter (IVCD) measurement-could provide complementary information to guide the management of HD patients. Method We assessed MBIS, LUC at 28 typical sites, and IVCD in 18 HD patients enrolled in the HD maintenance program. LUC and IVCD measurements were performed three times-before, during, and after HD, MBIS only before and after HD. For MBIS measurement, we used the Body Composition Monitor (Fresenius Medical Care, Bad Homburg, Germany), and for LUC and IVCD, we used an ultrasound machine (Esaote MyLabOmega, Genoa, Italy). Ultrafiltration during HD was not adjusted for LUC, IVCD, and MBIS. Overhydration (OH) was defined as > 2L with MBIS, > 15 LUC, and < 40% collapsibility index (CI) on IVCD. Results The mean age of participants was 61 (IQR, 47-74) years, and thirteen (72.2%) were male. The average dialysis vintage of our patients was 105 months (IQR, 30-155). According to the OH criteria before, during, and after HD, 13 (72%), 2 (11%) patients were overhydrated according to MBIS, 10 (56%), 7 (39%), 3 (17%) patients according to LUC, and 13 (72%), 12 (67%), and 11 (61%) patients according to CI. We found no correlation between systolic blood pressure (BP), diastolic BP, MBIS, LUC, and CI before, during, and after HD, except that systolic BP after HD correlated with MBIS (OH) after HD (r = 0.491; p = 0.039). Using the paired-samples T-test, we found a statistically significant difference between OH before and after HD (p < 0.001), between LUC before and during HD (p = 0.006), between LUC during and after HD (p = 0.002), and between LUC before and after HD (p < 0.001). Using the paired-samples T-test, no statistically significant difference was found between systolic, diastolic BP and CI before, during, and after HD. Conclusion Optimal assessment of fluid status in HD patients remains challenging and, according to our results, may require a combination of LUC and MBIS parameters.