Lung Ultrasound in Hemodialysis Patients: Is it Practical to Scan 28 Zones?

We read with great interest the study by Loutradis et al1Loutradis C. Papadopoulos C.E. Sachpekidis V. et al Lung ultrasound–guided dry weight assessment and echocardiographic measures in hypertensive hemodialysis patients: a randomized controlled study.Am J Kidney Dis. 2020; 75: 11-20Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar demonstrating the favorable effect of lung ultrasound–guided dry weight reduction on echocardiographic parameters in hemodialysis patients. Despite the limitations pointed out in the accompanying editorial,2Agrawal R. Toto R.D. Weir M.R. Extravascular lung water assessment by ultrasound to guide dry weight changes: ready for prime time?.Am J Kidney Dis. 2020; 75: 1-3Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar it is undeniable that lung ultrasound has the potential to become standard of care in managing these patients. Current evidence suggests that dialysis patients with higher B-line scores on lung ultrasound are at increased risk for death, even if they are asymptomatic.3Zoccali C. Torino C. Tripepi R. et al.Pulmonary congestion predicts cardiac events and mortality in ESRD.J Am Soc Nephrol. 2013; 24: 639-646Crossref PubMed Scopus (186) Google Scholar Moreover, it has been shown that the sensitivity of traditional physical examination to detect lung edema is much lower than that of lung ultrasound.4Torino C. Gargani L. Sicari R. et al.The agreement between auscultation and lung ultrasound in hemodialysis patients: the LUST Study.Clin J Am Soc Nephrol. 2016; 11: 2005-2011Crossref PubMed Scopus (92) Google Scholar We briefly comment on the lung scanning technique. A 28-zone method has been adopted by most studies, including the present one, which involves scanning 16 sites on the right hemithorax and 12 on the left. Though relatively easy to learn, it is cumbersome to use in day-to-day clinical practice and is inconvenient for patients. We routinely use an 8-zone method that involves scanning 2 anterior and 2 lateral zones on each hemithorax to assess volume status in our dialysis patients.5Arun Thomas E.T. Mohandas M.K. George J. Comparison between clinical judgment and integrated lung and inferior vena cava ultrasonography for dry weight estimation in hemodialysis patients.Hemodial Int. 2019; 23: 494-503Crossref PubMed Scopus (9) Google Scholar More recently, a 4-zone method has been described in patients with heart failure, in which the presence of 7 or more B-lines at hospital discharge conferred poor prognosis6Platz E. Campbell R.T. Claggett B. et al.Lung ultrasound in acute heart failure: prevalence of pulmonary congestion and short- and long-term outcomes.JACC Heart Fail. 2019; 7: 849-858Crossref PubMed Scopus (77) Google Scholar (Fig 1). Future studies should consider comparing these simplified scanning techniques with the standard 28-zone method and establishing correlates. We believe this would encourage more nephrologists to incorporate lung ultrasound as an adjunct to physical examination in the care of dialysis patients. The authors declare that they have no relevant financial interests. Received November 17, 2019. Accepted November 29, 2019, after editorial review by an Associate Editor and a Deputy Editor. Lung Ultrasound–Guided Dry Weight Assessment and Echocardiographic Measures in Hypertensive Hemodialysis Patients: A Randomized Controlled StudyAmerican Journal of Kidney DiseasesVol. 75Issue 1PreviewLeft ventricular (LV) hypertrophy and dysfunction are associated with adverse outcomes in hemodialysis patients. Hypertension and hypervolemia play important roles in these cardiac abnormalities. We report on the prespecified secondary outcome, echocardiographic indexes of LV function, from a previously reported study of the effect of lung ultrasound (US)-guided dry weight reduction on systolic blood pressure. Full-Text PDF In Reply to ‘Lung Ultrasound in Hemodialysis Patients: Is it Practical to Scan 28 Zones?’American Journal of Kidney DiseasesVol. 75Issue 5PreviewWe thank Koratala and Ross1 for their comments on our study.2 Simplifying the 28-zone lung ultrasound technique to encourage more nephrologists to undertake it is an interesting proposal. We first would like to note that in our experience, the 28-zone method is not inconvenient or difficult to apply. This approach was introduced to replace the time-consuming posterior lung ultrasound scanning scheme3 and was proven to be reliable and quick (10-15 minutes) for application in clinical routine in dialysis. Full-Text PDF