Diagnostic performance of pulmonary ultrasonography and a clinical score for the evaluation of fluid overload in haemodialysis patients

Mickaël Bobot; Laurent Zieleskiewicz; Noémie Jourde-Chiche; Clarissa Von Kotze; Manon Ebersolt; Bertrand Dussol; Marion Sallée; Sophie Chopinet; Yvon Berland; Philippe Brunet; Thomas Robert

doi:10.1016/j.nephro.2020.10.008

Diagnostic performance of pulmonary ultrasonography and a clinical score for the evaluation of fluid overload in haemodialysis patients

Nephrol Ther. 2021 Feb;17(1):42-49. doi: 10.1016/j.nephro.2020.10.008. Epub 2021 Jan 13.

Authors

Affiliations

¹ Aix-Marseille University, Department of Nephrology, AP-HM, La Conception Hospital, 147, boulevard Baille, 13005 Marseille, France; C2VN Laboratory, Inserm 1263, INRAE 1260, Aix-Marseille University, Marseille, France. Electronic address: Mickael.bobot@gmail.com.
² Aix-Marseille University, Department of Anaesthesiology and Intensive Care, AP-HM, Nord Hospital, Marseille, France; C2VN Laboratory, Inserm 1263, INRAE 1260, Aix-Marseille University, Marseille, France.
³ Aix-Marseille University, Department of Nephrology, AP-HM, La Conception Hospital, 147, boulevard Baille, 13005 Marseille, France; C2VN Laboratory, Inserm 1263, INRAE 1260, Aix-Marseille University, Marseille, France.
⁴ Aix-Marseille University, Department of Nephrology, AP-HM, La Conception Hospital, 147, boulevard Baille, 13005 Marseille, France.
⁵ Aix-Marseille University, Department Digestive Surgery, AP-HM, La Timone Hospital, Marseille, France.

PMID: 33451937
DOI: 10.1016/j.nephro.2020.10.008

Abstract

Introduction: There is no feasible benchmark in daily routine to estimate the hydration status of haemodialysis patients, which is essential to their management.

Objective: We performed a study in haemodialysis patients to assess the diagnostic performance of pulmonary ultrasound and clinical examination for the evaluation of fluid overload using transthoracic echocardiography as a gold standard.

Methods: Thirty-one patients receiving chronic haemodialysis patients were included. Evaluation of hydration status was assessed weekly before haemodialysis sessions using clinical and Echo Comet Score from pulmonary ultrasound and transthoracic echocardiography (reference method).

Results: Five patients had a transthoracic echocardiography overload. Compared with transthoracic echocardiography, the diagnostic performance of the clinical overload score has a sensitivity of 100%, a specificity of 77%, a positive predictive value of 50% and a negative predictive value of 100% with a κ of 0.79. Only orthopnoea (P=0.008), jugular turgor (P=0.005) and hepatic-jugular reflux (P=0.008) were significantly associated with transthoracic echocardiography overload diagnosis. The diagnostic performance of Echo Comet Score by pulmonary ultrasound has a sensitivity of 80%, a specificity of 58%, a positive predictive value of 26% and a negative predictive value of 94%. Ten patients (32.3%) had an increase of extravascular pulmonary water without evidence of transthoracic echocardiography or clinical overload.

Conclusions: Our clinical score has a convincing diagnostic performance compared to transthoracic echocardiography and could be easily used in daily clinical routine to adjust dry weight. The evaluation of the overload using pulmonary ultrasound seems poorly correlated with the overload evaluated by transthoracic echocardiography. Extravascular pulmonary water undetected by clinical examination and transthoracic echocardiography remains a parameter that requires further investigation.

Keywords: Echocardiography; Fluid overload; Haemodialysis; Hydration status; Lung ultrasound.

MeSH terms

Echocardiography
Humans
Lung / diagnostic imaging
Renal Dialysis* / adverse effects
Ultrasonography
Water-Electrolyte Imbalance*