Value of lung ultrasound in detection of volume overload in children chronic kidney disease on regular hemodialysis: prospective cohort study

Abstract

BackgroundSeveral methods have emerged to predict the occurrence of early volume overload (VO) in pediatric patients with chronic kidney disease undergoing regular hemodialysis (HD). Nevertheless, achieving an accurate assessment remains challenging. Consequently, this study aimed to identify VO in pediatric HD patients using lung ultrasound (LUS). Additionally, the study sought to investigate the relationship between various clinical parameters employed to detect VO and the ultrasonographic B-line score.MethodsThis prospective observational cohort study was conducted on 30 pediatric patients with end-stage renal disease undergoing a maintenance HD program for 4 months. The clinical evaluation of the fluid status of pediatric patients involved using LUS pre-, intra, and post-HD. The study included the dry weight (DW) and non-DW groups; within these groups, the B-line scores were evaluated pre-, intra, and post-HD sessions. Tabulations were conducted to document the variations in body weight and B-line scores during pre-, intra-, and post-dialytic periods.ResultsThe results of the LUSs performed on the 30 pediatric patients pre-, intra, and post-HD revealed that the B-line scores significantly reduced post-HD in all pediatric patients with more significant reduction in non-dry weight group (p < 0.001). There was a positive relation between the total number of B-lines pre-HD and inter-dialytic weight gain, pre-dialytic blood pressure, and clinical fluid score (r = 0.811, p < 0.01; r = 0.59, p < 0.001; and r = 0.75, p < 0.001, respectively) and also post-dialysis. Eventually, dialytic weight loss exhibited a significant direct positive correlation to B-line score reduction (r = 0.891, p < 0.01).ConclusionsLUS is an innovative, simple noninvasive bedside method that provides real-time evaluation of fluid volume alterations in pediatric HD patients with chronic conditions. LUS shows excellent potential as a viable approach for assessing DW and non-dry weight in pediatric HD patients.