The clinical application of lung ultrasonography for pulmonary congestion in patients with peritoneal dialysis

WANG Jia-wei; LU Lai-shun; WANG Liang-yu; YANG Shu-hui; QU Liao-zhun; LI Gong-yu; LIN Pei-hong; WU Ze-gui; TANG Xiao-ling

doi:10.3969/j.issn.1001-9448.2017.06.012

Abstract：Objective To investigate the prevalence of pulmonary congestion (PC) and its risk factors in peritoneal dialysis patients,and to appraise the value of lung ultrasonography (LUS) in volume assessment in this population.Methods Ninety-eight peritoneal dialysis patients were divided into two groups according to B lines number,the no or mild PC group (B lineses ≤ 15) and the moderate to severe PC group (B lines ＞ 15).The differences in clinical parameters were compared between the two groups,and risk factors of PC were analyzed by binary logistic regression analysis.The consistency of volume assessment between LUS and lower extremity edema (LEE) was analyzed,and the correlation between B lines number and serum B-type natriuretic peptide (BNP) level was explored.Results Prevalence of PC was 52.0％,while that of moderate to severe PC was up to 37.8％.Compared with no or mild PC,pulmonary arterial hypertension (PAH),diabetes and NYHA class Ⅲ-Ⅳ were more common,while serum albumin,serum calcium and phosphorus product were lower in the moderate to severe PC group (P ＜ 0.01).Multivariate analysis showed that diabetes,hypoalbuminemia and PAH were independent risk factors of PC.Among those with LEE,83.3％ exhibited PC in LUS.However,only 39.2％ presented LEE among those with PC (Kappa ＜0.4,P ＜0.01).The number of B lines was significantly correlated with the level of BNP (r--0.692,P ＜ 0.01).Conclusion Prevalence of PC in peritoneal dialysis patients is high.Diabetes,hypoalbuminemia and PAH are associated with the occurrence of PC.LEE poorly predicts PC.LUS could serve as a novel useful tool in guiding early diagnosis and intervention of volume overload.