Validating a Simplified Lung Ultrasound Protocol for Detection and Quantification of Pulmonary Edema in Patients With Chronic Kidney Disease Receiving Maintenance Hemodialysis

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Abstract
Objectives: Pulmonary edema is a common clinical problem and lung ultrasound (LUS) presents an efficient method for evaluating this pathology. This study aims to investigate if a clinically efficient LUS protocol can quantify the level of extravascular lung fluid in patients receiving hemodialysis, and to develop a simplified B‐line scoring system based on this protocol.Methods: A simple 8‐area LUS approach was used for the assessment of the extravascular fluid status in patients before, during, and after receiving hemodialysis. The LUS assessments were compared to the amount of removed fluid over time. To determine the best B‐line score system, different scorings for each zone were tested in a linear mixed model with pseudo R‐square model fit against removed fluid. The B‐line score was further validated through correlations with changes in oxygen saturation, grade of dyspnea, and body weight over time.Results: A total of 53 patients were included and examined on 108 hemodialysis occasions. Median fluid removal was 2.3 L. The B‐line score model with best fit was a score of 0 points in a zone with 0 or 1 B‐lines, 1 point with 2 or 3 B‐lines, 2 points with 3 or more B‐lines, and 3 points with any interstitial confluence. Using this B‐line score, we found a significant association with amount of removed fluid, oxygen saturation, grade of dyspnea, and change in body weight.Conclusion: A straightforward protocol for LUS and B‐line score system was shown valid for quantification of pulmonary edema and fluid removal in hemodialysis patients. The scoring system developed here can be useful also in other patient groups, but this requires further validation.

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