In Reply to “Pulse of Prudence: Navigating Isolated Lung Ultrasound in Hemodialysis Patients”

We thank Bhasin-Chhabra and Koratala1Bhasin-Chhabra B. Koratala A. Pulse of prudence: navigating isolated lung ultrasound in hemodialysis patients.Kidney Med. 2024; 6100862https://doi.org/10.1016/j.xkme.2024.100862Abstract Full Text Full Text PDF Scopus (1) Google Scholar for their interest in our study.2Chang E.H. Tugman M.J. Assimon M.A. et al.Lung ultrasound, bioimpedance spectroscopy, and physical examination for volume assessment in hospitalized hemodialysis patients: a diagnostic test study.Kidney Med. 2024; 6: 1-4Abstract Full Text Full Text PDF Scopus (1) Google Scholar They underscore the limitations of lung ultrasound for differentiating between cardiogenic and pneumogenic B-lines and identifying excess fluid that is accessible to ultrafiltration with dialysis, especially in the presence of infection, right-sided heart failure, and valvular dysfunction.3Al-Saray M.Z. Ali A. Lung ultrasound and caval indices to assess volume status in maintenance hemodialysis patients.POCUS J. 2023; 8: 52-59Crossref PubMed Google Scholar,4Wetmore J.B. Molony J.T. Liu J. et al.Readmissions following a hospitalization for cardiovascular events in dialysis patients: a retrospective cohort study.J Am Heart Assoc. 2018; 7e007231Crossref PubMed Scopus (15) Google Scholar Indeed, these limitations of the interpretation of lung ultrasound led to our decision to study the utility of lung ultrasound among patients with dialysis-dependent chronic kidney failure in the hospital, a setting where infection and lung and/or cardiac pathology are common. As noted by Bhassin-Chhabra and Koratala,1Bhasin-Chhabra B. Koratala A. Pulse of prudence: navigating isolated lung ultrasound in hemodialysis patients.Kidney Med. 2024; 6100862https://doi.org/10.1016/j.xkme.2024.100862Abstract Full Text Full Text PDF Scopus (1) Google Scholar we attempted to limit the influence of pulmonary conditions by excluding patients with major lung pathology. However, other underlying conditions, known limitations of lung ultrasound such as operator skill and incomplete accessibility of all lung fields,5Lerchbaumer M.H. Lauryn J.H. Bachmann U. et al.Point-of-care lung ultrasound in COVID-19 patients: inter- and intra-observer agreement in a prospective observational study.Sci Rep. 2021; 1110678Crossref Scopus (29) Google Scholar as well as the imperfection of bioimpedance spectroscopy as a gold standard6Davies S.J. Davenport A. The role of bioimpedance and biomarkers in helping to aid clinical decision-making of volume assessments in dialysis patients.Kidney Int. 2014; 86: 489-496Abstract Full Text Full Text PDF PubMed Scopus (239) Google Scholar may have contributed to the relatively weak agreement between lung ultrasound– and bioimpedance spectroscopy–measured volume statuses in our study. We agree that additional research aimed at identifying more accurate whole-body approaches to volume assessment, including other ultrasound examinations, among hospitalized, dialysis-dependent patients is needed. The authors declare that they have no relevant financial interests. Received February 15, 2024. Accepted February 19, 2024 after editorial review by the Editor-in-Chief. Pulse of Prudence: Navigating Isolated Lung Ultrasound in Patients Receiving HemodialysisKidney MedicineVol. 6Issue 8PreviewWe commend Chang, et al1 for exploring the role of lung ultrasound (LUS) in hospitalized hemodialysis patients. Given the rising interest in point-of-care ultrasonography (POCUS) among nephrologists, particularly isolated LUS, we wish to highlight some considerations for its cautious use. Although acknowledging the exclusion of patients with severe pulmonary fibrosis in this study, it is noteworthy that B-lines are also frequently seen in patients with recent infections and the prevalence of COVID-19 during the study period (2019-2021) adds complexity to the interpretation.