FP723PULMONARY CONGESTION AND MORTALITY RISK PREDICTION IN HAEMODIALYSIS PATIENTS

Abstract

Introduction and Aims: The use of lung ultrasonography to evaluate extravascular lung water and its consequences has received growing attention in different clinical areas, including, in recent years, end‐stage renal disease patients treated by haemodialysis (HD). Pulmonary congestion is highly prevalent and often asymptomatic among patients with end‐stage renal disease treated with HD, but whether its presence improves risk prediction above and beyond bioimpedance or cardiac parameters. Methods: The aim of our study was to test the prognostic value of extravascular lung water measured by a simple, well validated ultrasound B‐lines score (BLUS) in a single center study that enrolled 173 HD patients. Hydration status was evaluated by bioimpedance (body composition monitoring ‐ BCM) and by USLC before the midweek dialysis session. An echocardiographic evaluation was performed at the same time in all patients. Results: During a median follow‐up period of 22 months, 31 patients died. Using ROC curve analysis we identified a cut‐off for predicting the mortality risk associated with pulmonary congestion. Patients with less than 21 lung comets had a reduced all‐cause mortality risk even after multiple adjustments. In the subgroup analysis, this predictive ability is maintained only in the patients that had a LVMI ≥ 154.04 g/m2,7 (HR=6.39, 95% CI=2.64‐15.49, p for interaction=0.021). Adding BLUS to a prediction model didn't improve the discrimination or the reclassification ability of this model. By comparison, adding relative fluid overload (as determined by BCM measurements) to the same prediction model improved both the discrimination and the reclassification capacity of the model. Conclusions: Lung congestion is associated with the mortality risk in a HD population, but the addition of BLUS to a prediction model, as compared to the addition of relative fluid overload, didn't improve risk prediction abilities of this model. (Figure Presented).