Ultrasonografija pluća u proceni hipervolemije kod bolesnika na hemodijalizi
Sažetak
Uvod/Cilj. Procena stanja volemije bolesnika na hroničnom programu hemodijalize (HD) je teška uprkos postojećim razvijenim tehnikama. Cilj ove studije je bio da pokaže adekvatnost i efikastnost ultrazvuka pluća (UZP) i B linijskog skora (BLS) u proceni stanja volemije kod bolesnika na HD u poređenju sa drugim tehnikama: određivanjem dijametra donje šuplje vene (DŠVD) ultrazvukom, ehokardiografijom (ECHO) i određivanjem nivoa B tipa natriuretskog peptida (BNP) u krvi. Metode. UZP, ehokardiografija sa ultrasonografijom donje šuplje vene u inspirijumu (DŠVDi) i ekspirijumu (DŠVDe) i uzorkovanje krvi za određivanje BNP su učinjeni pre i posle HD kod 83 bolesnika. Rezultati. Registrovano je značajno smanjenje BLS, DŠVDi i DŠVDe, nivoa BNP i nekoliko ehokardiografskih (EHO) parametara (dimenzije leve pretkomore, komore u sistoli i dijastoli i zapremina leve pretkomore) (p < 0.001). Postojala je značajna korelacija između BLS i BNP pre i posle HD (p = 0.01), između BLS i EHO parametara (p = 0.01), i slabija, ali ipak značajna korelacija između BLS i DŠVDi i DŠVDe pre HD (p = 0.01). Zaključak. Svim tehnikama je uspešno procenjena hipervolemija pre i posle HD. Vrednosti BNP su korelisale sa nalizom UZP pre i posle HD, a vrednosti DŠVDi i DŠVDe su korelisale sa UZP, uglavnom, pre HD. UZP je jeftina i jednostavna tehnika, može se izvoditi pored postelje i pouzdano koristiti za procenu stanja volemije kod bolesnika na HD.
Reference
Jaeger JQ, Mehta RL. Assessment of dry weight in hemodialysis: an overview. J Am Soc Nephrol 1999; 10(2): 392‒403.
Siriopol D, Hogas S, Voroneanu L, Onofriescu M, Apetrii M, Ole-niuc M, et al. Predicting mortality in haemodialysis patients: a comparison between lung ultrasonography, bioimpedance data and echocardiography parameters. Nephrol Dial Transplant 2013; 28(11): 2851–9.
Flythe JE, Xue H, Lynch KE, Curhan GC, Brunelli SM. Associa-tion of Mortality Risk with Various Definitions of Intradialyt-ic Hypotension. J Am Soc Nephrol 2014; 26(3): 724‒34.
Ortiz A, Covic A, Fliser D, Fouque D, Goldsmith D, Kanbay M, et al. Epidemiology, contributors to, and clinical trials of mortal-ity risk in chronic kidney failure. Lancet 2014; 383(9931): 1831–43.
Covic A, Siriopol D, Voroneanu L. Use of Lung Ultrasound for the Assessment of Volume Status in CKD. Am J Kidney Dis 2018; 71(3): 412–22.
Donadio C, Bozzoli L, Colombini E, Pisanu G, Ricchiuti G, Picano E, et al. Effective and timely evaluation of pulmonary conges-tion.Medicine (Baltimore) 2015; 94(6): e473.
Basso F, Manani SM, Cruz DN, Teixeira C, Brendolan A, Nalesso F, et al. Comparison and reproducibility of techniques for flu-id status assessment in chronic hemodialysis patients. Cardi-orenal Med 2013; 3(2): 104–12.
Sabaghian T, Hajibaratali B, Samavat S. Which echocardio-graphic parameter is a better marker of volume status in he-modialysis patients? Ren Fail 2016; 38(10): 1659–64.
Santos-Araújo C, Leite-Moreira A, Pestana M. Clinical value of natriuretic peptides in chronic kidney disease. Nefrología 2015; 35(3): 227–33.
Jozwiak M, Teboul JL, Monnet X. Extravascular lung water in critical care: recent advances and clinical applications. Ann In-tensive Care 2015; 5(1): 38.
Mallamaci F, Benedetto FA, Tripepi R, Rastelli S, Castellino P, Tripepi G, et al. Detection of pulmonary congestion by chest ultrasound in dialysis patients. JACC Cardiovasc Imaging 2010; 3(6): 586–94.
Lichtenstein D, Mauriat P. Lung Ultrasound in the Critically Ill Neonate. Curr Pediatr Rev 2012; 8(3): 217‒23.
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 17(12): 1321‒60.
Weitzel WF, Hamilton J, Wang X, Bull JL, Vollmer A, Bowman A, et al. Quantitative Lung Ultrasound Comet Measurement: Method and Initial Clinical Results. Blood Purif 2015; 39(1–3): 37–44.
Zoccali C, Torino C, Tripepi R, Tripepi G, D’Arrigo G, Postorino M, et al. Pulmonary congestion predicts cardiac events and mortality in ESRD. J Am Soc Nephrol 2013;24(4):639–46.
Trezzi M, Torzillo D, Ceriani E, Costantino G, Caruso S, Dama-vandi PT, et al. Lung ultrasonography for the assessment of rapid extravascular water variation: evidence from hemodialy-sis patients. Intern Emerg Med 2013; 8(5): 409–15.
Cheung AK, Sarnak MJ, Yan G, Berkoben M, Heyka R, Kaufman A, et al. Cardiac diseases in maintenance hemodialysis pa-tients: Results of the HEMO Study. Kidney Int 2004; 65(6): 2380‒9.
Enia G, Torino C, Panuccio V, Tripepi R, Postorino M, Aliotta R, et al. Asymptomatic pulmonary congestion and physical func-tioning in hemodialysis patients. Clin J Am Soc Nephrol 2013; 8(8): 1343–8.
Panuccio V, Enia G, Tripepi R, Torino C, Garozzo M, Battaglia GG, et al. Chest ultrasound and hidden lung congestion in peritoneal dialysis patients. Nephrol Dial Transplant 2012; 27(9): 3601–5.
Paudel K, Kausik T, Visser A, Ramballi C, Fan SL. Comparing lung ultrasound with bioimpedance spectroscopy for evaluat-ing hydration in peritoneal dialysis patients. Nephrology (Carl-ton) 2015; 20(1): 1–5.
Saad M, Mansour W, Kamal J, Ross H, Kapoor M, Brown C, et al. 355 B-lines on lung ultrasound in end stage renal disease pa-tients post hemodialysis: accuracy and precision-interim analy-sis. Ann Emerg Med 2015; 66(4): S128.
Vitturi N, Dugo M, Soattin M, Simoni F, Maresca L, Zagatti R, et al. Lung ultrasound during hemodialysis: the role in the as-sessment of volume status. Int Urol Nephrol 2014; 46(1): 169–74.
Alexiadis G, Panagoutsos S, Roumeliotis S, Stibiris I, Markos A, Kantartzi K, et al. Comparison of multiple fluid status assess-ment methods in patients on chronic hemodialysis. Int Urol Nephrol 2017; 49(3): 525–32.
Sivalingam M, Vilar E, Mathavakkannan S, Farrington K. The role of natriuretic peptides in volume assessment and mortali-ty prediction in Haemodialysis patients. BMC Nephrol 2015; 16(1): 218.
Laveborn E, Lindmark K, Skagerlind M, Stegmayr B. NT-proBNP and troponin T levels differ after haemodialysis with a low versus high flux membrane. Int J Artif Organs 2015; 38(2): 69‒75.
Chang ST, Chen CL, Chen CC, Lin FC, Wu D. Enhancement of quality of life with adjustment of dry weight by echocardio-graphic measurement of inferior vena cava diameter in pa-tients undergoing chronic hemodialysis. Nephron Clin Pract 2004; 97(3): c90‒7.