Volume Assessment in Paediatric Hemodialysis Using Lung Ultra Sonography

Abstract

Background: It is a significant challenge clinically to optimize the weight of children and infants. It is our hypothesis that in children receiving dialysis fluid overload can be quantified using lung ultrasound. Objectives: 1. To determine the frequency of diagnosing pulmonary edema using lung ultrasound and clinical examination. 2. To determine association of percentage decrease in weight with number of B-lines in children with renal failure undergoing hemodialysis Methods: This cross sectional study was conducted in Division of Pediatric Nephrology, Paediatric unit II, Mayo Hospital Lahore from June 2020 till December 2020 after approval of hospital committee. Patients aged 6 to 16 years undergoing regular hemodialysis after chronic kidney disease were enrolled. Lung ultrasound examinations were performed before start of dialysis and after completion of dialysis. B lines were measured on the ultrasound along with comparing the proportional increase in weight from the target weight. Results: Eighty one lung ultrasound assessments were performed in total. Mean age was 10.4±3.3 years. There were 56(69.1%) males and 25 (30.8%) female patients. Mean percentage decrease in weight was 5.5±2.4% before dialysis and 0.96±0.6% after dialysis, p-value <0.001. Pre dialysis B lines were 10.9±6.2 which significantly reduced after dialysis, post dialysis B lines were 4.3±2.7, p-value was significant i.e. <0.001. In 25(30.8%) patients clinical examination revealed pulmonary edema while 51(62.9%) patients had pulmonary congestion detected by lung ultrasound before dialysis. Conclusions: In children and infants receiving dialysis lung ultrasound is a sensitive and practical method of evaluating subclinical fluid overload. Decrease in number of B-lines after dialysis represents decrease in weight after dialysis. More number of patients were diagnosed using lung ultrasound as compare to clinical examination.