Lung ultrasound in the assessment of hypervolemia in hemodialysis patients - two case reports

Abstract

Introduction. Hemodialysis patients often have chronic volume overload, hypervolemia, which may cause severe complications. In some patients hypervolemia is masked, without any signs and symptoms, such as hypertension, edema and bibasilar crackles on lung auscultation. Lung ultrasound can be used to detect these patients. Pre- and post-dialysis lung ultrasound can be used to quantify lung congestion using the B line score. High post-dialysis B line score can identify patients with residual hypervolemia and adequate measures can be taken (increasing ultrafiltration, extended duration of hemodialysis, additional dialysis sessions). Case Reports. The first patient was a 57-year-old male. The hemodialysis vintage was 4 years. His interdialytic weight gain was 2.8 kg. The lung ultra?sound was performed before and after dialysis and B line score was calculated. The pre-dialysis score was 15 and post-dialysis score was 2. The second patient was a 72-year-old male. The hemodialysis started 5 years before. This patient was noncompliant with the medical advice of his physician regarding diet and medications. His interdialytic weight gain was 5.6 kg. His pre-dialysis score was 26 and post-dialysis score was 15. Both patients were without signs and symptoms of hypervolemia after dialysis. Nevertheless, the second patient was 1.6 kg over his dry weight after dialysis. An additional dialysis session was scheduled, after which his post-dialysis B line score fell to 5. Conclusion. Lung ultrasound can be used to assess volume status in dialysis patients. It can identify hypervolemia in asymptomatic patients and allow necessary corrections.