Lung Ultrasound Guided Management of Pulmonary Congestion in Hemodialysis

Background: Pulmonary congestion (PC) is frequent in Hemodialysis (HD) patients and is associated with deleterious prognosis. Lung ultrasound (LUS) accurately quantifies PC; however, many methods exist to evaluate PC using LUS. Here, we validate a simplified LUS-guided protocol for managing PC in HD patients and explore its impact on blood pressure control. Methods: We enrolled 100 HD patients from 6 dialysis units in 3 countries in a multi-center randomized controlled trial. All patients had LUS after their mid-week session on days 1, 15, 30, 45, and 60. LUS was performed using the 8-zone method to obtain a global B-line score (BLS). Doctors and nurses performed LUS at the bedside. Dry weight was adjusted according to the standard of care in the control group, while it was reduced by 500 g if BLS was above five on day 1 and by 500 g further on Day 15 if BLS was still above 5 in the active group. Blood pressure home monitoring (BPHM) was obtained weekly. Results: The mean BLS on day 1 (13 ± 9) decreased to (8 ± 5) on day 60 (P < 0.001) in the active group. In contrast, the control group showed no significant changes in B-line score on day 60 compared to baseline. HBPM on day 60 was similar to the baseline in both groups. Applying this protocol did not increase the intra-dialytic hypotension frequency. Conclusions: This simplified LUS-guided protocol for managing PC was effective and safe in HD patients and could be considered for inclusion in standard care practices. Nurses and advanced caregivers may perform LUS in HD units. LUS-guided management may have a positive impact on blood pressure control.