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. 2022 Nov 29;12(12):2990.
doi: 10.3390/diagnostics12122990.

Pre-Dialysis B-Line Quantification at Lung Ultrasound Is a Useful Method for Evaluating the Dry Weight and Predicting the Risk of Intradialytic Hypotension

Marco Allinovi  1 , Giulia Palazzini  1   2 , Gianmarco Lugli  2   3 , Iacopo Gianassi  1 , Lorenzo Dallari  1   2 , Selene Laudicina  1   2 , Marco Gregori  4 , Francesco Rossi  1 , Daniele Giannerini  1 , Roberta Cutruzzulà  1 , Egrina Dervishi  1 , Maria Biagini  1 , Calogero Lino Cirami  1
Affiliations

Pre-Dialysis B-Line Quantification at Lung Ultrasound Is a Useful Method for Evaluating the Dry Weight and Predicting the Risk of Intradialytic Hypotension

Marco Allinovi et al. Diagnostics (Basel). .

Abstract

Intradialytic hypotension (IDH) is a frequent and well-known complication of hemodialysis, occurring in about one third of patients. An integrated approach with different methods is needed to minimize IDH episodes and their complications. In this prospective observational study, recruited patients underwent a multiparametric evaluation of fluid status through a lung ultrasound (LUS) with the quantification of B-lines, a physical examination, blood pressure, NT-proBNP and chest X-rays. The evaluation took place immediately before and at the end of the dialysis session, and the patients were divided into IDH and no-IDH groups. We recruited a total of 107 patients. A pre-dialysis B-line number ≥ 15 showed a high sensitivity in fluid overload diagnosis (94.5%), even higher than a chest X-ray (78%) or physical examination (72%) alone. The identification at the beginning of dialysis of <8 B-lines in the overall cohort or <20 B-lines in patients with NYHA 3−4 class are optimal thresholds for identifying those patients at higher risk of experiencing an IDH episode. In the multivariable analysis, the NYHA class, a low pre-dialysis systolic BP and a low pre-dialysis B-line number were independent risk factors for IDH. At the beginning of dialysis, the B-line quantification at LUS is a valuable and reliable method for evaluating fluid status and predicting IDH episodes. A post-dialysis B-line number <5 may allow for an understanding of whether the IDH episode was caused by dehydration, probably due to due to an overestimation of the dry weight.

Keywords: B-lines; dry weight; fluid overload; intradialytic hypotension; lung ultrasound.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
ROC curves in the overall cohort. (A) ROC curve plotting number of B-lines with the likelihood that participants had intradialytic hypotension; (B) ROC curve plotting number of B-lines with the likelihood that participants had overall fluid overload; (C) ROC curve plotting number of post-dialytic B-lines with the likelihood that participants had intradialytic hypotension.
Figure 2
Figure 2
Comparative analysis of different fluid status assessment methods to predict IDH episodes. ROC curve analysis for the overall cohort. (A) ROC curves plotting number of B-lines, BVM values, clinical evaluation, chest X-ray and the NT-proBNP values in relation to the likelihood that participants had an IDH. (B) Table shows AUC values and pairwise comparisons with B-lines score.
Figure 3
Figure 3
A proposed lung ultrasound approach in hemodialysis in order to drive ultrafiltration prescriptions. Nephrologists should adopt B-line quantification by LUS as a bedside approach to prevent IDH and drive the ultrafiltration prescription during the whole hemodialytic session. The identification of <8 B-lines at the beginning of dialysis can be helpful for identifying those patients at higher risk of experiencing an IDH episode, and consequently nephrologists might consider reducing/minimizing ultrafiltration. Conversely, the identification of <5 B-lines at the end of a dialysis session complicated by an IDH episode is highly suggestive of dehydration, probably due to an overestimation of the dry weight, and consequently nephrologists might consider increasing the dry weight.
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