• Claudia Torino, Luna Gargani, Rosa Sicari, Krzysztof Letachowicz, Robert Ekart, Danilo Fliser, Adrian Covic, Kostas Siamopoulos, Aristeidis Stavroulopoulos, Ziad A Massy, Enrico Fiaccadori, Alberto Caiazza, Thomas Bachelet, Itzchak Slotki, Alberto Martinez-Castelao, Marie-Jeanne Coudert-Krier, Patrick Rossignol, Faikah Gueler, Thierry Hannedouche, Vincenzo Panichi, Andrzej Wiecek, Giuseppe Pontoriero, Pantelis Sarafidis, Marian Klinger, Radovan Hojs, Sarah Seiler-Mussler, Fabio Lizzi, Dimitrie Siriopol, Olga Balafa, Linda Shavit, Rocco Tripepi, Francesca Mallamaci, Giovanni Tripepi, Eugenio Picano, Gérard Michel London, and Carmine Zoccali.
• Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
• Clin J Am Soc Nephrol. 2016 Nov 7; 11 (11): 2005-2011.

Background And ObjectivesAccumulation of fluid in the lung is the most concerning sequela of volume expansion in patients with ESRD. Lung auscultation is recommended to detect and monitor pulmonary congestion, but its reliability in ESRD is unknown.Design, Setting, Participants, & MeasurementsIn a subproject of the ongoing Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, we compared a lung ultrasound-guided ultrafiltration prescription policy versus standard care in high-risk patients on hemodialysis. The reliability of peripheral edema was tested as well. This study was on the basis of 1106 pre- and postdialysis lung ultrasound studies (in 79 patients) simultaneous with standardized lung auscultation (crackles at the lung bases) and quantification of peripheral edema.ResultsLung congestion by crackles, edema, or a combination thereof poorly reflected the severity of congestion as detected by ultrasound B lines in various analyses, including standard regression analysis weighting for repeated measures in individual patients (shared variance of 12% and 4% for crackles and edema, respectively) and κ-statistics (κ ranging from 0.00 to 0.16). In general, auscultation had very low discriminatory power for the diagnosis of mild (area under the receiver operating curve =0.61), moderate (area under the receiver operating curve =0.65), and severe (area under the receiver operating curve =0.68) lung congestion, and the same was true for peripheral edema (receiver operating curve =0.56 or lower) and the combination of the two physical signs.ConclusionsLung crackles, either alone or combined with peripheral edema, very poorly reflect interstitial lung edema in patients with ESRD. These findings reinforce the rationale underlying the Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, a trial adopting ultrasound B lines as an instrument to guide interventions aimed at mitigating lung congestion in high-risk patients on hemodialysis.Copyright © 2016 by the American Society of Nephrology.

36 keywords...

hide…