Document Detail


Pulmonary congestion predicts cardiac events and mortality in ESRD.
MedLine Citation:
PMID:  23449536     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Pulmonary congestion is highly prevalent and often asymptomatic among patients with ESRD treated with hemodialysis, but whether its presence predicts clinical outcomes is unknown. Here, we tested the prognostic value of extravascular lung water measured by a simple, well validated ultrasound B-lines score (BL-US) in a multicenter study that enrolled 392 hemodialysis patients. We detected moderate-to-severe lung congestion in 45% and very severe congestion in 14% of the patients. Among those patients with moderate-to-severe lung congestion, 71% were asymptomatic or presented slight symptoms of heart failure. Compared with those patients having mild or no congestion, patients with very severe congestion had a 4.2-fold risk of death (HR=4.20, 95% CI=2.45-7.23) and a 3.2-fold risk of cardiac events (HR=3.20, 95% CI=1.75-5.88) adjusted for NYHA class and other risk factors. Including the degree of pulmonary congestion in the model significantly improved the risk reclassification for cardiac events by 10% (P<0.015). 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.
Authors:
Carmine Zoccali; Claudia Torino; Rocco Tripepi; Giovanni Tripepi; Graziella D'Arrigo; Maurizio Postorino; Luna Gargani; Rosa Sicari; Eugenio Picano; Francesca Mallamaci;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2013-02-28
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  24     ISSN:  1533-3450     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-04-01     Completed Date:  2013-06-06     Revised Date:  2014-04-01    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  639-46     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Extravascular Lung Water / ultrasonography*
Female
Heart Failure / mortality*
Humans
Hyperemia / ultrasonography*
Kidney Failure, Chronic / mortality*,  therapy
Lung / blood supply*,  ultrasonography*
Male
Middle Aged
Prognosis
Regression Analysis
Renal Dialysis
Risk Factors
Survival Analysis
Investigator
Investigator/Affiliation:
Giovanni Alati / ; Rosalia Boito / ; Rosita Lucà / ; Graziella Bonanno / ; Simonetta Cassani / ; Antonio Chippari / ; Teresa Cicchetti / ; Anna Clementi / ; Maurizio Garozzo / ; Domenico Lo Gozzo / ; Domenico Mancuso / ; Francesco Mollica / ; Giuseppe Natale / ; Vincenzo Panuccio / ; Arcangelo Sellaro /
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