MP562ASESSMENT OF BODY FUILD VOLUME STATUS BY LUNG ULTRASOUND IN CHRONIC HEMODIALYSIS PATIENTS

Abstract

Introduction and Aims: Dry weight (DW) is the surrogate marker of the body fluid volume status in chronic hemodialysis (HD) patients. Clinical indices such as physical examination, cardio-thoracic ratio, cardiac ultrasonography and bio-markers (BNP, hANP) have been used for determining DW. Recently, transthoracic lung ultrasound has been applied in intensive care areas for evaluating extravascular lung water volume since it is minimally invasive. The calculated comet score is used to qualify lung water content. Several reports have shown the clinical utility of comet scores for the evaluation of asymptomatic pulmonary congestion of HD patients. However, currently in Japan, few reports exist on the assessment of body fluid volume status using lung comet score. We aimed to examine whether the comet score is clinically useful in body fluid volume assessment in HD patients. Methods: We measured the lung comet score among the outpatient HD patients in Tomishiro Central Hospital. The duration of study was between February 2015 and September 2015. The comet score was measured after informed consent at both pre and post HD session and the laboratory data such as blood pressure, weight change after HD (% BW), and cardio-thoracic ratio were obtained and compared with the cardiac ultrasound parameters. Results: A total of 61 HD patients, 30 males and 31 females, were studied. The mean (SD) age was 64.4 ± 12.1 years old and the duration of HD was 124 ± 76 months, diabetes was 41 patients (67.2%). The comet score was 8.7 ± 11.3 at pre-HD, and 4.8 ± 6.7 at post-HD. It was 5 or more in 20 patients and less than 5 in 41 patients at post HD session, Cardiac ultrasound parameters in those with comet score of 5 or more were significantly higher than those in the group of comet score of less than 5: LAD (40 mm vs. 36 mm, P <0.01), LA volume (72 vs. 51, P <0.01), LA volume index (44 vs. 31, P <0.01), and E / e' (20 vs. 14, P <0.05). However, there was no difference in the % BW, cardio thoracic ratio, IVC, LVDd, LVDs, EF, and IVS. Discussion. As shown by the DOPPS, survival of Japanese ESRD patients is the best in the world. This is true even the eGFR at start of dialysis is low as 4 to 6 ml/min/1.73m2, probably reflecting better medical care at pre-ESRD stage and meticulous care after starting dialysis. Among HD patients, we have been focusing to the inter-dialysis weight gain, in particular, on weekend. However, they would be become under-nourished if too much restriction on salt and water. In our dialysis center, the mean Geriatric Nutritional Risk Index (GNRI) was 94.7, and the under-nutrition (GNRI<91.2) was about 27%. Conclusions: Comet score may be useful for body fluid volume assessment in HD patients. Future study is necessary to prove the prognostic value of comet score.