scholarly journals Lung ultrasound as tool to evaluate fluid accumulation in dialysis patients

2022 ◽  
Author(s):  
Maria-Eleni Alexandrou ◽  
Marieta P. Theodorakopoulou ◽  
Pantelis A. Sarafidis
Keyword(s):  
Lung Ultrasound ◽  
Current Knowledge ◽  
Management Strategies ◽  
Extracellular Volume ◽  
Volume Overload ◽  
Dry Weight ◽  
Adverse Outcomes ◽  
Hydration Status ◽  
Lung Water ◽  
Clinical Benefits

Background: Volume overload is the main mechanism of BP elevation in end-stage kidney disease (ESKD) patients undergoing hemodialysis or peritoneal dialysis and has been linked to adverse outcomes and increased mortality in this population. Summary: This review discusses current knowledge on lung ultrasound as a tool for detection of extracellular volume overload through evaluation of extravascular lung water content. We describe the principles of lung US, the main protocols to apply it in clinical practice, and accumulated data evidence regarding its associations with cardiovascular events and mortality. We also summarize available evidence on the effect of lung-ultrasound guided volume management strategies on BP control, echocardiographic parameters and major outcomes in patients undergoing dialysis. Key Messages: Among interventions attempting to reduce the burden of cardiovascular disease in ESKD, effective management of volume overload represents an unmet clinical need. Assessment of hydration status by lung-ultrasound is a cheap, easy to employ and real-time technique that can offer accurate dry weight assessment leading to several clinical benefits.

scholarly journals Volume overload in hemodialysis: diagnosis, cardiovascular consequences, and management

2020 ◽  
Author(s):  
Charalampos Loutradis ◽  
Pantelis A Sarafidis ◽  
Charles J Ferro ◽  
Carmine Zoccali
Keyword(s):  
Time Window ◽  
Diastolic Pressure ◽  
Current Knowledge ◽  
Volume Overload ◽  
Dry Weight ◽  
Left Ventricular ◽  
Bioimpedance Spectroscopy ◽  
Fluid Removal ◽  
Clinical Criteria ◽  
Long Time

Abstract Volume overload in haemodialysis (HD) patients associates with hypertension and cardiac dysfunction and is a major risk factor for all-cause and cardiovascular mortality in this population. The diagnosis of volume excess and estimation of dry weight is based largely on clinical criteria and has a notoriously poor diagnostic accuracy. The search for accurate and objective methods to evaluate dry weight and to diagnose subclinical volume overload has been intensively pursued over the last 3 decades. Most methods have not been tested in appropriate clinical trials and their usefulness in clinical practice remains uncertain, except for bioimpedance spectroscopy and lung ultrasound (US). Bioimpedance spectroscopy is possibly the most widely used method to subjectively quantify fluid distributions over body compartments and produces reliable and reproducible results. Lung US provides reliable estimates of extravascular water in the lung, a critical parameter of the central circulation that in large part reflects the left ventricular end-diastolic pressure. To maximize cardiovascular tolerance, fluid removal in volume-expanded HD patients should be gradual and distributed over a sufficiently long time window. This review summarizes current knowledge about the diagnosis, prognosis and treatment of volume overload in HD patients.

scholarly journals Lung Ultrasound to Quantitatively Evaluate Extravascular Lung Water Content and its Clinical Significance

2020 ◽  
Author(s):  
Guo Guo ◽  
Xue-Feng Zhang ◽  
Jing Liu ◽  
Hai-Feng Zong
Keyword(s):  
Extravascular Lung Water ◽  
Lung Ultrasound ◽  
Rabbit Model ◽  
Dry Weight ◽  
Type I ◽  
Lung Water ◽  
Arterial Blood Gas ◽  
Injection Volume ◽  
Arterial Blood ◽  
B Lines

Abstract Background:B-line assessment with lung ultrasound (LUS) has recently been proposed as a reliable, noninvasive semiquantitative tool for evaluating extravascular lung water (EVLW). Currently, there has been no easy quantitative method to evaluate EVLW by LUS. To establish a simple, accurate and clinically operable method for quantitative assessment of EVLW using LUS. Methods:Forty-five New Zealand rabbits were randomized into 9 groups (n=5). After anesthesia, each group of rabbits was injected with different amounts of warm sterile NS (0 ml/kg, 2 ml/kg, 4 ml/kg, 6 ml/kg, 8 ml/kg, 10 ml/kg, 15 ml/kg, 20 ml/kg, 30 ml/kg) via the endotracheal tube. Each rabbit was examined by LUS before and after NS injection. At the same time, the spontaneous respiratory rate (RR, breaths per minute), heart rate (HR, bpm) and arterial blood gas (ABG) of the rabbits were recorded. Then, both lungs were dissected to obtain the wet and dry weight and conduct a complete histological examination.Results:Injecting NS into the lungs through a tracheal tube can successfully establish a rabbit model with increased EVLW. When theNS injection volume is 2~6 ml/kg, comet-tail artifacts and B-lines are the main patterns found on LUS; as additional NS is injected into the lungs, the rabbits' RR gradually increases, while their HR gradually decreases. Confluent B-lines grow gradually but significantly, reaching a dominant position when the NS injection volume reaches 6~8 ml/kg and predominating almost entirely when the NS injection volume is 8~15 ml/kg; at that time, rabbits' RRs and HRs decrease sharply, and the ABG indicated type I respiratory failure (RF). Compact B-lines occur and predominate almost entirely when the NS injection volume reaches 10 ml/kg and 15~20 ml/kg, respectively. At that time, rabbits begin to enter cardiac and respiratory arrest, and ABG shows type II RF and metabolic acidosis (MA).Conclusion: LUS can estimate EVLW content based on the type of B-line.We can give clinical treatment depending on the type of LUS B-line.

MO737EVALUATION OF EXTRAVASCULAR FLUID IN HEMODIALYSIS PATIENTS BY LUNG ULTRASOUND IN COMPARISON WITH BIOIMPEDANCE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Anastasiia Putintceva ◽  
Irina Zdanova ◽  
Ekaterina Tsukanova ◽  
Julia Fadeeva ◽  
Ashot Esayan
Keyword(s):  
Lung Ultrasound ◽  
Statistical Significance ◽  
The Body ◽  
Water Volume ◽  
Maintenance Hemodialysis ◽  
Hydration Status ◽  
Lung Water ◽  
Cardiac Pacemakers ◽  
Fluid Status ◽  
B Lines

Abstract Background and Aims The aim of study was to compare the lung ultrasound (LUS) and bioimpedance analysis (BIA) as methods to assess the hydration (fluid) status in maintenance hemodialysis (MHD) patients. Method The comparative analysis was performed in 87 MHD patients aged 24 to 82 years (43 women, and 44 men). Patients with cardiac pacemakers and permanent catheters as vascular access were excluded from the study. Extravascular lung water (EVLW) in MHD patients was assessed simultaneously by LUS (Acuson X150 ultrasound system with a CH5-2 curvilinear transducer, Siemens) and by the bioimpedance spectroscopy (BIS) (Bodystat Multiscan 5000) with frequency range of 5-1000K Hz. Both LUS and BIS were performed before and 30 minutes after the hemodialysis (HD) session in the second and third sessions of the week. Ultrasonic measurements were performed by summing LUS comets or B-lines along four anatomical lines (parasternal, mid-clavicular, anterior, middle, and posterior axillary lines) from II to V intercostal spaces on the right and from the II to IV intercostal spaces on the left. The quantitative assessment of B-lines (B-lines score, BLS) was performed according to Picano E. et al. [2006]: normohydration – zero degree (<4 B lines) with the absence of EVLW, overhydration (OH) – 1st degree (5-14 BLS), 2nd degree OH (15-30 BLS), and 3d degree OH – >30 BLS with an insignificant, moderate and severe amount of EVLW, respectively. The body hydration status assessment technique by BIS was based on the overhydration (OH) index, the total body water volume, extra- and intracellular water, and the body composition. Patient's fluid status classified as normohydration (1.0-1.0 L), moderate OH (>1.0-<2.5 L), and severeOH (>2.5 L), and dehydration (<1.0 L) [Henry C. Lukaski et al., 2019]. The LUS do not allow assessing the state of dehydration, therefore, the normohydration by LUS was the sum of normo- and dehydration by BIS. We used SPSS Statistics 21.0 software for statistical processing of the data. To assess the correlation between BLS and OH indicators, we used Spearman's rank correlation coefficient. The statistical significance level was assumed to be 0.05. Results Data of the body fluid status using LUS and BIS before and after HD-session fully coincided in 33 of 87 MHD patients, partially coincided in 20 patients before and in 25 patients after HD-session. LUS and BIS didn’t coincide completely in only 9 patients. Statistically significant correlation was revealed between BLS and OH before (Rs=0.336; p<0.01), and after (Rs=0,317, p<0,01) HD session. A positive correlation between BLS and OH data was revealed in 53 patients, whose results were almost identical before (Rs=0,488, p<0.01), and in 58 patients after (Rs=0,658, p<0.01) HD session. Conclusion BIS remains the gold standard for the assessment of over-, normo- and dehydration in MHD patients. LUS is a simple and adequate technique for assessing the hydration status in MHD patients, and it is comparable to BIS in assessing over-, as well as normohydration. However, the LUS doesn’t allow diagnosing the body dehydration.

scholarly journals Blood Volume Monitoring: A Clinical Tool to Guide Ultrafiltration in Volume Control and Optimisation of Intradialytic Blood Pressure

2021 ◽  
pp. 70-78
Author(s):  
Stephen Mahony ◽  
Frank Ward
Keyword(s):  
Blood Volume ◽  
Extracellular Volume ◽  
Volume Overload ◽  
Dry Weight ◽  
Volume Status ◽  
Volume Control ◽  
Current Evidence ◽  
Chronic Haemodialysis ◽  
Intradialytic Hypotension ◽  
Arterial Blood

The importance of extracellular volume control and avoidance of volume overload has been well documented in relation to the management of patients with chronic haemodialysis. Chronic volume overload results in poorly controlled hypertension, increased cardiovascular events, and increased all-cause mortality. Traditional methods of dry weight assessment have relied on clinical assessment to guide volume status. The challenge of achieving the balance between dry weights and preventing intradialytic complications is a formidable one. In order to achieve this, reproducible and sensitive methods are desirable to aid objective quantification of volume status. One such method is by the use of blood volume monitoring, which is achieved by real-time calculation of changes in relative blood volume via a cuvette placed in the arterial blood-line, which can be used to guide ultrafiltration targets during the haemodialysis session. This review article examines the use of blood volume monitoring as a tool to guide ultrafiltration during dialysis and to examine the current evidence to supports its use in assessing dry weight and in preventing intradialytic hypotension events.

scholarly journals Mechanisms and Treatment of Intradialytic Hypertension

2016 ◽  
Vol 41 (1-3) ◽  
pp. 188-193 ◽  
Author(s):  
Peter Noel Van Buren ◽  
Jula K. Inrig
Keyword(s):  
Endothelial Cell ◽  
Vascular Resistance ◽  
Mortality Risk ◽  
Cell Function ◽  
Management Strategies ◽  
Extracellular Volume ◽  
Cell Activity ◽  
Dry Weight ◽  
Hemodialysis Patients ◽  
Endothelial Cell Function

Background: Intradialytic hypertension is a condition where there is an increase in blood pressure (BP) from pre- to post-hemodialysis; this condition has been recently identified as an independent mortality risk factor in hypertensive hemodialysis patients. The mechanisms and management of intradialytic hypertension have been explored in numerous research studies over the past few years. Summary: Patients with intradialytic hypertension have been found to be more chronically volume overloaded compared to other hemodialysis patients, although no causal role has been established. Patients with intradialytic hypertension have intradialytic vascular resistance surges that likely explain the BP increase during dialysis. Acute intradialytic changes in endothelial cell function have been proposed as etiologies for the increase in vascular resistance, although it is unclear if endothelin-1 or some other vasoconstrictive peptide is responsible. There is an association between dialysate to serum sodium gradients and BP increase during dialysis in patients with intradialytic hypertension, although it is unclear if this is related to endothelial cell activity or acute osmolar changes. In addition to probing the dry weight of patients with intradialytic hypertension, other management strategies include lowering dialysate sodium and changing antihypertensives to include carvedilol or other poorly dialyzed antihypertensives. Key Messages: Hemodialysis patients with intradialytic hypertension have an increased mortality risk compared to patients with modest decreases in BP during dialysis. Intradialytic hypertension is associated with extracellular volume overload in addition to acute increases in vascular resistance during dialysis. Management strategies should include reevaluation of dry weight and modification of both the dialysate prescription and medication prescription.

scholarly journals The efficacy of managing fluid overload in chronic peritoneal dialysis patients by a structured nurse-led intervention protocol

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Man Ching Law ◽  
◽  
Bonnie Ching-Ha Kwan ◽  
Janny Suk-Fun Fung ◽  
Kai Ming Chow ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Fluid Overload ◽  
Extracellular Volume ◽  
Volume Overload ◽  
Volume Status ◽  
Hydration Status ◽  
Dietary Control ◽  
Symptomatic Group ◽  
Intervention Protocol

Abstract Background Extracellular volume overload is a common problem in peritoneal dialysis (PD) patients and is associated with excessive mortality. We determine the effectiveness of treating PD patients with extracellular volume overload by a structured nurse-led intervention program. Methods The hydration status of PD patients was screened by bioimpedance spectroscopy (BIS). Fluid overload was defined as overhydration volume ≥ 2 L. Patients were classified into Symptomatic and Asymptomatic Groups and were managed by a structured nurse-led intervention protocol that focused on education and motivation. Hypertonic cycles were given for short term symptom relief for the Symptomatic group. Patients were followed for 12 weeks for the change in volume status, blood pressure, knowledge and adherence as determined by standard questionnaires. Results We recruited 103 patients (53 Symptomatic, 50 Asymptomatic Group. There was a significant reduction in overhydration volume 4 weeks after intervention, which was sustained by week 12; the overall reduction in overhydration volume was 0.96 ± 1.43 L at 4 weeks, and 1.06 ± 1.70 L at 12 weeks (p < 0.001 for both). The improvement was significant for both Symptomatic and Asymptomatic Groups. There was a concomitant reduction in systolic blood pressure in the Asymptomatic (146.9 ± 20.7 to 136.9 ± 19.5 mmHg, p = 0.037) but not Symptomatic group. The scores of knowledge, adherence to dietary control and advices on daily habit at week 4 were all significantly increased, and the improvement was sustained at week 12. Conclusions The structured nurse-led intervention protocol has a lasting benefit on the volume status of PD patients with extracellular volume overload. BIS screening allows prompt identification of volume overload in asymptomatic patients, and facilitates a focused effort on this high risk group.

scholarly journals Quantitative Lung Ultrasonography for the Nephrologist: Applications in Dialysis and Heart Failure

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0003972021
Author(s):  
Nathaniel Reisinger ◽  
Abhilash Koratala
Keyword(s):  
Heart Failure ◽  
Acute Care ◽  
Extravascular Lung Water ◽  
Lung Ultrasound ◽  
Volume Overload ◽  
Care Utilization ◽  
Lung Ultrasonography ◽  
Lung Water ◽  
Acute Care Utilization ◽  
B Lines

Volume overload and its attendant increase in acute care utilization and cardiovascular morbidity and mortality represents a critical challenge for the practicing nephrologist. This is particularly true among patients with ESKD on HD where pre-dialysis volume overload and intradialytic and postdialytic hypovolemia account for almost a third of all cost for the Medicare dialysis benefit. Quantitative lung ultrasound is a tool for assessing the extent of extravascular lung water which outperforms physical exam and plain chest radiography. B-lines are vertical hyperechoic artifacts present in patients with increased extravascular lung water. B-lines have been shown to decrease dynamically during the hemodialysis treatment in proportion to ultrafiltration volume. Among patients with chronic heart failure, titration of diuretics based on the extent of pulmonary congestion noted on lung ultrasonography has been shown to decrease recurrent acute care utilization. Early data from randomized-controlled trials of lung ultrasound-guided ultrafiltration therapy among patients with ESKD on HD have shown promise for potential reduction in recurrent episodes of decompensated heart failure and cardiovascular events. Ultimately lung ultrasound may predict those who are ultrafiltration tolerant and could be used to decreased acute care utilization and thus cost in this population.

scholarly journals The Effect of Gut Bacteria on the Physiology of Red Palm Weevil, Rhynchophorus ferrugineus Olivier and Their Potential for the Control of This Pest

Insects ◽  
2021 ◽  
Vol 12 (7) ◽  
pp. 594
Author(s):  
Qian-Xia Liu ◽  
Zhi-Ping Su ◽  
Hui-Hui Liu ◽  
Sheng-Ping Lu ◽  
Bing Ma ◽  
...  
Keyword(s):  
Molecular Mechanisms ◽  
Current Knowledge ◽  
Management Strategies ◽  
Gut Bacteria ◽  
Economic Losses ◽  
Rhynchophorus Ferrugineus ◽  
Intestinal Immunity ◽  
Red Palm Weevil ◽  
Nutrient Metabolism ◽  
Palm Weevil

Red Palm Weevil (RPW), Rhynchophorus ferrugineus Olivier, is a notorious pest, which infests palm trees and has caused great economic losses worldwide. At present, insecticide applications are still the main way to control this pest. However, pesticide resistance has been detected in the field populations of RPW. Thus, future management strategies based on the novel association biological control need be developed. Recent studies have shown that the intestinal tract of RPW is often colonized by multiple microbial species as mammals and model insects, and gut bacteria have been found to promote the growth, development and immune activity of RPW larvae by modulating nutrient metabolism. Furthermore, two peptidoglycan recognition proteins (PGRPs), PGRP-LB and PGRP-S1, can act as the negative regulators to modulate the intestinal immunity to maintain the homeostasis of gut bacteria in RPW larvae. Here, we summarized the current knowledge on the gut bacterial composition of RPW and their impact on the physiological traits of RPW larvae. In contrast with metazoans, it is much easier to make genetic engineered microbes to produce some active molecules against pests. From this perspective, because of the profound effects of gut bacteria on host phenotypes, it is promising to dissect the molecular mechanisms behind their effect on host physiology and facilitate the development of microbial resource-based management methods for pest control.

scholarly journals Fusarium basal rot: profile of an increasingly important disease in Allium spp.

2021 ◽  
Author(s):  
Dung Le ◽  
Kris Audenaert ◽  
Geert Haesaert
Keyword(s):  
Disease Management ◽  
Cultural Practices ◽  
Current Knowledge ◽  
Management Strategies ◽  
Future Directions ◽  
Basal Rot ◽  
Major Constraint ◽  
Fusarium Basal Rot ◽  
Chemical Pesticides ◽  
Important Disease

AbstractFusarium basal rot (FBR) is a soil-borne disease that affects Allium species worldwide. Although FBR has long been recognized as a major constraint to the production of economically important Allium species, information that could support disease management remains scattered. In this review, the current knowledge on the causal agents, symptomology and epidemiology, impact, and management strategies of FBR is synthesized. We highlight that FPR is associated with different complexes of several Fusarium species, of which Fusarium oxysporum and F. proliferatum are the most prevalent. These pathogenic complexes vary in composition and virulence, depending on sites and hosts, which can be challenging for disease management. Research to improve disease management using chemical pesticides, resistance cultivars, biocontrol agents, and cultural practices has achieved both promising results and limitations. Finally, research needs and future directions are proposed for the development of effective FBR management strategies.

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