Introduction: Sonographic technologies can estimate extravascular lung water (EVLW) in hemodialysis (HD) patients. This study investigated the suitability of a handheld scanner in contrast to a portable scanner for quantifying EVLW in hospitalized patients requiring HD. Methods: In this prospective study, 54 hospitalized HD patients were enrolled. Bedside lung ultrasound was performed within 30 min before and after dialysis using handheld (phased array transducer, 1.7–3.8 MHz) and portable (curved probe, 5–2 MHz) ultrasound devices. Eight lung zones were scanned for total B-lines number (TBLN). The maximum diameter of inferior vena cava (IVC) was measured. We performed Passing-Bablok regression, Deming regression, Bland-Altman, and logistic regression analysis. Results: The 2 devices did not differ in measuring TBLN and IVC (p #x3e; 0.05), showing a high correlation (r = 0.92 and r = 0.51, respectively). Passing-Bablok regression had a slope of 1.11 and an intercept of 0 for TBLN, and the slope of Deming regression was 1.02 within the CI bands of 0.94 and 1.11 in the full cohort. TBLN was logarithmically transformed for Bland-Altman analysis, showing a bias of 0.06 (TBLN = 1.2) between devices. The slope and intercept of the Deming regression in IVC measurements were 0.77 and 0.46, respectively; Bland-Altman plot showed a bias of −0.07. Compared with predialysis, TBLN significantly (p #x3c; 0.001) decreased after dialysis, while IVC was unchanged (p = 0.16). Univariate analysis showed that cardiovascular disease (odds ratio [OR] 8.94 [2.13–61.96], p = 0.002), smoking history (OR 5.75 [1.8–20.46], p = 0.003), and right pleural effusion (OR 5.0 [1.2–25.99], p = 0.03) were strong predictors of EVLW indicated by TBLN ≥ 4. Conclusion: The lung and IVC findings obtained from handheld and portable ultrasound scanners are comparable and concordant. Cardiovascular disease and smoking history were strong predictors of EVLW. The use of TBLN to assess EVLW in hospitalized HD patients is feasible. Further studies are needed to determine if TBLN can help guide volume removal in HD patients.
Cardiorenal Med

中文翻译：

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需要血液透析的住院患者血管外肺水的超声评估：一项前瞻性观察研究

简介：超声技术可以估计血液透析 (HD) 患者的血管外肺水 (EVLW)。本研究调查了手持式扫描仪与便携式扫描仪相比在需要 HD 的住院患者中量化 EVLW 的适用性。方法：在这项前瞻性研究中，54 名住院 HD 患者入组。使用手持式（相控阵换能器，1.7-3.8 MHz）和便携式（弯曲探头，5-2 MHz）超声设备在透析前后 30 分钟内进行床边肺部超声检查。扫描八个肺区的总 B 线数 (TBLN)。测量下腔静脉（IVC）的最大直径。我们进行了 Passing-Bablok 回归、Deming 回归、Bland-Altman 和逻辑回归分析。结果：这两种设备在测量 TBLN 和 IVC 方面没有差异（p #x3e；0.05），显示出高相关性（分别为r = 0.92 和r = 0.51）。Passing-Bablok 回归的斜率为 1.11，TBLN 的截距为 0，Deming 回归的斜率为 1.02，在整个队列的 CI 带 0.94 和 1.11 内。TBLN 被对数转换用于 Bland-Altman 分析，显示设备之间的偏差为 0.06 (TBLN = 1.2)。IVC 测量中戴明回归的斜率和截距分别为 0.77 和 0.46；Bland-Altman 图显示偏差为 -0.07。与透析前相比，透析后TBLN显着降低（p #x3c；0.001），而IVC无变化（p= 0.16）。单变量分析显示心血管疾病（比值比 [OR] 8.94 [2.13-61.96]，p = 0.002）、吸烟史（OR 5.75 [1.8-20.46]，p = 0.003）和右侧胸腔积液（OR 5.0 [ 1.2-2] ） 25.99], p = 0.03) 是 TBLN ≥ 4 指示的 EVLW 的强预测因子。结论：从手持式和便携式超声扫描仪获得的肺和 IVC 发现具有可比性和一致性。心血管疾病和吸烟史是 EVLW 的强预测因子。使用 TBLN 评估住院 HD 患者的 EVLW 是可行的。需要进一步的研究来确定 TBLN 是否可以帮助指导 HD 患者的体积去除。
心肾医学