Pulmonary congestion can predict risk of death and cardiac events in patients with end-stage renal disease undergoing dialysis, according to a study published online ahead of print in the Journal of the American Society of Nephrology.
Carmine Zoccali, MD, from the National Research Council-Institute of Biomedicine in Pisa, Italy, and colleagues used a well validated ultrasound B-lines score (BL-US) to measure the extravascular lung water in 392 patients with end-stage renal disease receiving hemodialysis at one of multiple centers.
The researchers found that 45% of participants had moderate-to-severe lung congestion and 14% had very severe congestion. Seventy-one percent of patients with moderate-to-severe lung congestion were asymptomatic or presented slight symptoms of heart failure. Compared with patients having mild or no congestion, patients with very severe congestion had a 4.2-fold increased risk of death and a 3.2-fold increased risk of cardiac events, even after adjusting for New York Heart Association class. The study also revealed a significant 10% improvement in risk reclassification for cardiac events with the inclusion of the degree of pulmonary congestion into the model.
“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,” the authors concluded.