CORRELATION BETWEEN FINDINGS OF FLUID OVERLOAD BY BIOIMPENDANCE AND ULTRASOUND MARKERS OF LUNG AND VENOUS CONGESTION

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https://storage.unitedwebnetwork.com/files/1099/81aecdec5463d1bcc6b2baa0a4e3e865.pdf

Abstract Title

First Name *

Ramon

Last Name *

Medina-Gonzalez

Co-author 1

Manuel Arizaga-Napoles man.arizaga.napoles@gmail.com Hospital Civil de Guadalajara Nephrology Guadalajara

Co-author 2

Jonathan Chavez-Iñiguez jonarchi_10@hotmail.com Hospital Civil de Guadalajara Nephrology Guadalajara

Co-author 3

Jochen G. Raimann jochen.raimann@rriny.com Renal Research Institute Data Analytics New York

Co-author 4

Co-author 5

Co-author 6

Co-author 7

Co-author 8

Co-author 9

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Introduction

Fluid Overload (FO) is a critical determinant of cardiovascular mortality among hemodialysis patients. Despite its clinical significance, accurately assessing volume status remains a challenge in nephrology. This study aims to correlate bioimpedance spectroscopy (BIS) with ultrasonographic markers of pulmonary and venous congestion to diagnose FO in a hemodialysis population

The primary objective was to diagnose FO, as defined by BIS, using ultrasonographic markers of lung and venous congestion. The secondary objective was to identify an optimal cutoff point in the inferior vena cava (IVC) diameter to detect volume overload as indicated by bioimpedance

Methods

In this descriptive cross-sectional observational study, 78 patients undergoing hemodialysis had their volume status assessed by BIS and ultrasound 15 minutes prior to and 45 minutes after their hemodialysis session. Pulmonary ultrasound across 12 zones determined B-line presence and lung congestion grade, and venous ultrasound followed the VExUS protocol

Results

Boxplots illustrated OH and %ECW distribution, with significant differences between groups categorized by LUS scores (p < 0.001). Bonferroni-adjusted multiple comparisons revealed significant differences in OH and %ECW across LUS groups. Sensitivity and specificity analyses evaluated the ability of tests to detect FO in the presence of ultrasound-evidenced pulmonary congestion. A ROC curve analysis of the IVC diameter showed an AUC of 0.808, indicating a reasonable discrimination capacity, with an optimal decision-making threshold at an IVC diameter of 1.65 cm

Conclusions

Ultrasonographic findings of pulmonary and venous congestion are effective in detecting FO in hemodialysis patients. The use of bedside ultrasound alongside BIS can enhance the evaluation of volume status, potentially guiding better clinical management of these patients

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