#5448 INCIDENCE OF ACUTE PULMONARY EDEMA AFTER THE SYSTEMATIC USE OF ULTRASOUND B-LINES

Abstract

Abstract Background and Aims Acute pulmonary edema (APE) due to fluid overload is considered the most feared complication in hemodialysis patients. Various diagnostic tests have been proposed to assess fluid status in patients with end stage kidney failure (ESKF) and among these lung ultrasound (by measuring the number of B-Lines) is emerging as a promising tool to identify pulmonary congestion in this patient-population. Method In the setting of a retrospective study, we pragmatically compared the incidence rate of APE in our center before and after the implementation of lung ultrasound as a routine practice in our unit. Two periods were considered. A pre-implementation period [from 01/01/2007 to 31/12/2008, total person-time: 1913 months/patient, n = 98 patients (Group 1), 85 prevalent and 13 incident patients] and a post-implementation period [from 01/01/2017 to 31/12/2018, total person-time: 2061 months/patient, n = 108 patients (Group 2), 81 prevalent and 27 incident patients]. By accurately reviewing the electronic medical records, all episodes of APE were counted, i.e. all episodes characterized by sudden or worsening dyspnea associated with signs of salt and water overload, confirmed by chest auscultation or chest X-Ray, which required an additional dialysis session and excluding events due to infectious or irritating problems. Results The two groups (Group 1 vs Group 2) were quite similar between them as for age (64±15 vs 67±14 years, p = 0.06), proportion of males (65% vs 62%, p = 0.37) and median dialysis vintage [40 months (interquartile Range, IQR: 16–93 months) vs 46 months (IQR: 12–92), p = 0.76]. The two groups did not differ as for diabetes (21% vs 25%, P = 0.33), hypertension (75% vs 71%, p = 0.36), and smoking habit (29% vs 28%, p = 0.51). Of note, the proportion of patients with background cardiovascular comorbidities was significantly higher in patients of Group 2 (enrolled in the post-implementation period) than in those of Group 1 (31% vs 19%, p = 0.04]. A total of 37 APE episodes in 18 patients (from 1 to 4 episodes per patient) were identified in patients of Group 1 vs 7 APE episodes in 5 patients (from 1 to 2 episodes per patient) in those of Group 2. The incidence rate of APE was 82% lower in patients during the post-implementation period (4 episodes per 100 patients/year, 95% CI: 1–8) than in those during the post implementation period (23 episodes per 100 patient/year, 95% CI: 17–32) (incidence rate ratio: 0.18, 95% CI: 0.10-0.29, p<0.001). Conclusion The systematic use of lung ultrasound (simple, easy to learn, rapid and non-invasive method, easily performed at the patient's bed) in every day clinical practice drastically reduced (-82%) the episodes of APE in hemodialysis patients. Further observational and interventional studies are needed to confirm these results.