Abstract
Abstract Background and Aims Lung ultrasound (LUS) helps detecting pulmonary congestion (PC) among haemodialysis (HD) patients. This study investigated the relation between PC, cardiac function parameters, volume status and ultrafiltration, as well as chronic inflammation in two consecutive HD sessions with different inter-dialytic intervals. Method Prospective observational study, where 18 HD patients underwent LUS to calculate the B Lines Score (BLS) using the 8 zone method, inferior vena cava (IVC) dimensions measurement, and echocardiography before and after their regular first (S1) and second (S2) HD sessions of the week. The cut-off for BLS was fixed as 0.54 line per zone. Total body volume using Bio-electrical Impedance Analysis (BIA) was measured before both HD sessions besides serum NT-pro BNP (N-Terminal Pro-Brain Natriuretic Peptide Type B) levels. Moreover, circulating markers of inflammation (soluble urokinase Plasminogen Activator Receptor [suPAR] and soluble Suppression of Tumorigenicity 2 [sST2]) were measured before each session. Results Interdialytic interval did not impact BLS, which was high before and after both sessions. There was no significant difference in BLS before and after S1, whereas the difference was significant in S2 (P: 0.03, ES: 0.54). BIA was correlated to PC only before S2 (R² = 0.374, P = 0.007). BLS and the systolic cardiac function represented by the ejection fraction were correlated only after S2. Nt-ProBNP levels and BLS were correlated before both sessions (R²: 0.421, P: 0.004; R² = 0.505, P = 0.001), respectively. Cardiac diastolic function was correlated with BLS before S1 (R² = 0.476, P = 0.002) and after S2 (R² = 0.193, P = 0.034). Mean levels (± SD, ng/ml) of suPAR (7.88 ± 3.07), (7.78 ± 3.02) remained significantly above the normal range (< 4 ng/ml), while sST2 levels reached 2-fold the upper normal value in some patients (27.4 ± 17.8). Conclusion PC is common in HD patients even after reaching their dry weight at the end of their two consecutive sessions. It is not only correlated to volume status and cardiac function. Chronic inflammation may be involved in PC pathophysiology. A better management strategy is thus needed to better reduce PC in HD patients.
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