Ultrasound Helps Diagnose Lung Congestion in Dialysis Patients

Asymptomatic lung congestion has been shown to increase dialysis patients’ risks of dying prematurely or experiencing myocardial infarctions or other cardiac events, according to recent research. The findings also revealed that utilizing lung ultrasound to identify this congestion aids in diagnosing patients at risk. Italian investigators recently measured the degree of lung congestion in 392 dialysis patients by using a very simple and inexpensive technique—lung ultrasound.

Lung congestion due to fluid accumulation is very common among kidney failure patients on dialysis, but it frequently does not cause any symptoms. To see whether such asymptomatic congestion affects dialysis patients’ health, Carmine Zoccali, MD, from Ospedali Riuniti (Reggio Calabria, Italy) and his colleagues published their study findings February 28, 2013, in the Journal of the American Society of Nephrology (JASN).

Among the major findings (1) Lung ultrasound revealed very severe congestion in 14% of patients and moderate-to-severe lung congestion in 45% of patients. (2) Among those with moderate-to-severe lung congestion, 71% were asymptomatic. (3) Compared with those having slight or no congestion, those with very severe congestion had a 4.2-fold increased risk of dying and a 3.2-fold increased risk of experiencing heart attacks or other cardiac events over a two-year follow-up period. (4) Lastly, asymptomatic lung congestion identified by lung ultrasound was a better predictor of patients’ risk of dying prematurely or experiencing cardiac events than symptoms of heart failure.

By evaluating subclinical pulmonary edema can help better establish dialysis patients’ prognoses, according to the findings. “More importantly, our findings generate the hypothesis that targeting subclinical pulmonary congestion may improve cardiovascular health and reduce risk from cardiovascular death in the dialysis population, a population at an extremely high risk,” said Dr. Zoccali. Fluid in the lungs may be decreased with longer and/or more frequent dialysis.

The researchers will soon initiate a clinical trial that will integrate lung fluid measurements by ultrasound and will examine whether dialysis intensification in patients with asymptomatic lung congestion can reduce the risk of heart failure and cardiac events and prevent premature death.

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