Abstract
BackgroundLung ultrasound is a novel technique for detecting generalized fluid overload in children and adults with end-stage renal disease (ESRD). Echocardiography and bioimpedance spectroscopy are established methods, albeit variably adopted in clinical practice. We compared the practicality and accuracy of lung ultrasound with current objective techniques for detecting fluid overload in children with ESRD.MethodsA prospective observational study was performed to compare lung ultrasound B-lines, echocardiographic measurement of inferior vena cava parameters and bioimpedance spectroscopy in the assessment of fluid overload in children with ESRD on dialysis. The utility of each technique in predicting fluid overload, based on short-term weight gain, was assessed. Multiple linear regression models to predict fluid overload by weight were explored.ResultsA total of 22 fluid assessments were performed in 13 children (8 on peritoneal dialysis, 5 on haemodialysis) with a median age of 4.0 (range 0.8–14.0) years. A significant linear correlation was observed between the number of B-lines detected by lung ultrasound and fluid overload by weight (r = 0.57, p = 0.005). A non-significant positive linear correlation was observed between fluid overload by weight and bioimpedance spectroscopy (r = 0.43, p = 0.2), systolic blood pressure (r = 0.19, p = 0.4) and physical examination measurements (r = 0.19, p = 0.4), while a non-significant negative linear relationship was found between the inferior vena cava collapsibility index and fluid overload by weight (r = −0.24, p = 0.3). In multiple linear regression models, a combination of three fluid parameters, namely lung ultrasound B-lines, clinical examination and systolic blood pressure, best predicted fluid overload (R 2 = 0.46, p = 0.05).ConclusionsLung ultrasound may be superior to echocardiographic methods and bioimpedance spectroscopy in detecting volume overload in children with ESRD. Given the practicality and sensitivity of this new technique, it can be adopted alongside clinical examination and blood pressure in the routine assessment of fluid status in children with ESRD.
Highlights
Children, Upper Maudlin Street, Bristol BS2 8BJ, UKChronic fluid overload contributes to cardiovascular morbidity in children with end-stage renal disease (ESRD) [1,2,3]
Physical examination showed the least dissociation with blood pressure in one (4 %) of 22 physical examination scores (Fig. 5d). In this cohort of 13 infants and children with endstage renal disease (ESRD), fluid overload was best predicted using a combination of physical examination, blood pressure and lung ultrasound measurements
No significant predictive value from bioimpedance spectroscopy (BIS) or echocardiographic measurements was observed in the assessment of fluid overload in this study
Summary
Upper Maudlin Street, Bristol BS2 8BJ, UKChronic fluid overload contributes to cardiovascular morbidity in children with end-stage renal disease (ESRD) [1,2,3]. A number of techniques are available to assess fluid overload in adults and children with ESRD, including bioimpedance spectroscopy (BIS) [4,5,6,7], echocardiographic assessment of inferior vena cava (IVC) dimensions [8, 9] and lung ultrasound [10,11,12]. The aim of this study was to evaluate the accuracy of these three techniques in detecting fluid overload in children with ESRD and to compare them with clinical measures, including weight, physical examination and systolic blood pressure. Methods A prospective observational study was performed to compare lung ultrasound B-lines, echocardiographic measurement of inferior vena cava parameters and bioimpedance spectroscopy in the assessment of fluid overload in children with ESRD on dialysis. In multiple linear regression models, a combination of three fluid parameters, namely lung ultrasound B-lines, clinical examination and systolic blood pressure, best predicted fluid overload (R2 = 0.46, p = 0.05). Given the practicality and sensitivity of this new technique, it can be adopted alongside clinical examination and blood pressure in the routine assessment of fluid status in children with ESRD
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