Lung Ultrasound Guided Management of Pulmonary Congestion in Hemodialysis

Key Points A simplified lung ultrasound (LUS)–guided management approach safely reduced pulmonary congestion in patients undergoing hemodialysis. LUS may be performed by nurses and paramedics, making it even easier to integrate it into routine practice. LUS may contribute to better BP control in patients undergoing hemodialysis. Background Pulmonary congestion (PC) is frequent in hemodialysis patients and is associated with deleterious prognosis. Lung ultrasound (LUS) accurately quantifies PC; however, many methods exist to evaluate PC using LUS. Here, we validate a simplified LUS-guided protocol for managing PC in patients undergoing hemodialysis and explore its impact on BP control. Methods We enrolled 100 hemodialysis patients from six dialysis units in three countries in a multicenter randomized controlled trial. All patients had LUS after their mid-week session on days 1, 15, 30, 45, and 60. LUS was performed using the eight-zone method to obtain a global B-line score (BLS). Doctors and nurses performed LUS at the bedside. Dry weight was adjusted according to the standard of care in the control group, while it was reduced by 500 g if BLS was above five on day 1 and by 500 g further on day 15 if BLS was still above five in the active group. BP home monitoring was obtained weekly. Results The mean BLS on day 1 (13±9) decreased to 8±5 on day 60 ( P < 0.001) in the active group. By contrast, the control group showed no significant changes in BLS on day 60 compared with baseline. Home blood pressure monitoring on day 60 was similar to the baseline in both groups. Applying this protocol did not increase the intradialytic hypotension frequency. Conclusions This simplified LUS-guided protocol for managing PC was effective and safe in hemodialysis patients and could be considered for inclusion in standard care practices. Nurses and advanced caregivers may perform LUS in hemodialysis units. LUS-guided management may have a positive impact on BP control. Clinical Trial registry name and registration number: ClinicalTrials.gov, NCT06296160.