Fluid Status Assessment in Children on Regular Hemodialysis

Background: Fluid overload is a common complication of pediatric hemodialysis (HD) and precise volume status assessment is difficult to evaluate in growing children. Subjects and methods: This prospective cohort study was conducted on Children with chronic kidney disease stage 5 on maintenance hemodialysis, who enrolled from Pediatric Nephrology Unit, Cairo University. Volume status was assessed by calculating the percentage of weight gain, index of heart rate, blood pressure and respiratory rate, lung ultrasound (LUS), and bioimpedance spectroscopy (BIS) analysis. The primary aim of this study was to evaluate the usefulness of LUS and BIS as non-invasive assessment tools for fluid status in pediatric hemodialysis patients. The secondary aim was to describe and characterize the changes in fluid status before and after HD sessions. Result: The study included 38 children with a mean age of 10 years, predominantly male (55.3%). Notably, 42.1% of these children had consanguineous parents. Clinical signs improved after HD session, indicating that the dialysis sessions were generally effective (p < 0.001). Significant decrease in B-lines after HD measured by LUS, from 3.42 (±1.64) to 1.51 (±1.35) (P = 0.000). This reduction in B-lines suggests improved pulmonary status. There was statistically significant positive correlation between average weight gain% and ultrafiltration volume (r =0.489, p =0.002) reflecting importance of inter-dialytic weight gain (IDWG) as a fluid overload assessment tool. Conclusion: There was a significant reduction in B-line counts and thoracic fluid content post-dialysis illustrating the effectiveness of dialysis in alleviating pulmonary congestion associated with fluid overload.