Carmine Zoccali, MD, from the National Research Council-Institute of Biomedicine, in Pisa, Italy, and colleagues used a well validated ultrasound B-lines score (BL-US) to measure the extravascular lung water in 392 patients with end-stage renal disease receiving hemodialysis at one of multiple centers.
The researchers found that 45 percent of participants had moderate-to-severe lung congestion and 14 percent had very severe congestion. Seventy-one percent of patients with moderate-to-severe lung congestion 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 increased risk of death and a 3.2-fold increased risk of cardiac events, even after adjustments for New York Heart Association class. There was also a significant 10 percent improvement in risk reclassification for cardiac events with the inclusion of the degree of pulmonary congestion into the model.
"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," the authors write.