Pulmonary Congestion Predicts Cardiac Events and Mortality in ESRD

• Published in: Journal of the American Society of Nephrology Vol. 24; no. 4; pp. 639 - 646
• Main Authors: Zoccali, Carmine, Torino, Claudia, Tripepi, Rocco, Tripepi, Giovanni, D’Arrigo, Graziella, Postorino, Maurizio, Gargani, Luna, Sicari, Rosa, Picano, Eugenio, Mallamaci, Francesca
• Format: Journal Article
• Language: English
• Published: Washington, DC American Society of Nephrology 01.04.2013
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Clinical Epidemiology; Extravascular Lung Water - diagnostic imaging; Female; Heart Failure - mortality; Humans; Hyperemia - diagnostic imaging; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Lung - blood supply; Lung - diagnostic imaging; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Prognosis; Regression Analysis; Renal Dialysis; Renal failure; Risk Factors; Survival Analysis; Ultrasonography; Kidney disease; Heart; Nephrology; Urinary system disease; Chronic renal failure; Mortality; Lung; Terminal stage; Respiratory system; Epidemiology; Urology; Circulatory system; Predictive factor
• ISSN: 1046-6673; 1533-3450; 1533-3450
• DOI: 10.1681/ASN.2012100990

Pulmonary congestion is highly prevalent and often asymptomatic among patients with ESRD treated with hemodialysis, but whether its presence predicts clinical outcomes is unknown. Here, we tested the prognostic value of extravascular lung water measured by a simple, well validated ultrasound B-lines score (BL-US) in a multicenter study that enrolled 392 hemodialysis patients. We detected moderate-to-severe lung congestion in 45% and very severe congestion in 14% of the patients. Among those patients with moderate-to-severe lung congestion, 71% were asymptomatic or presented slight symptoms of heart failure. Compared with those patients having mild or no congestion, patients with very severe congestion had a 4.2-fold risk of death (HR=4.20, 95% CI=2.45-7.23) and a 3.2-fold risk of cardiac events (HR=3.20, 95% CI=1.75-5.88) adjusted for NYHA class and other risk factors. Including the degree of pulmonary congestion in the model significantly improved the risk reclassification for cardiac events by 10% (P<0.015). In summary, lung ultrasound can detect asymptomatic pulmonary congestion in hemodialysis patients, and the resulting BL-US score is a strong, independent predictor of death and cardiac events in this population.