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Lung ultrasound: a complementary dynamic method to estimate target weight in pediatric hemodialysis
Benjamin Moussler1, Arnaud Wiedemann2,3, Anne Mirguet4
1Pediatric Nephrology Department, University Hospital of Nancy, Nancy, 54000, France. b.moussler2@chru-nancy.fr.
Insights
Lung ultrasound (LUS) effectively assesses target weight in pediatric hemodialysis patients. This dynamic tool aids in fluid status evaluation and complements other methods for better patient management.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Critical Care Medicine
Background:
- Accurate target weight assessment in pediatric patients undergoing dialysis is complex due to growth.
- Lung ultrasound (LUS) shows potential for hydration assessment, but pediatric data are scarce.
Purpose of the Study:
- To evaluate the utility of lung ultrasound (LUS) in assessing target weight in children on hemodialysis.
- To compare LUS findings with established methods like NT-proBNP, bioimpedance analysis (BIA), and inferior vena cava (IVC) diameter.
Main Methods:
- A retrospective study analyzed 68 dialysis sessions in 10 pediatric hemodialysis patients.
- Target weight was assessed using clinical exam, NT-proBNP, BIA, IVC diameter, and a 12-zone LUS protocol.
- Mixed-effects regression models were employed to analyze associations.
Main Results:
- Lung ultrasound (LUS) scores significantly decreased post-dialysis (median 7 to 4).
- LUS correlated significantly with NT-proBNP levels (p=0.006) and showed a trend with clinical signs (p=0.072).
- Changes in LUS scores strongly correlated with dialysis-related weight loss (p<0.001).
Conclusions:
- Lung ultrasound (LUS) is a sensitive and dynamic tool for evaluating target weight in pediatric hemodialysis.
- LUS provides valuable information on extravascular fluid status, enhancing multimodal assessment.
- LUS should be integrated into target weight strategies, particularly when other methods show discordance.
Background:
Target weight assessment remains challenging, particularly in children, where ongoing growth adds complexity. Lung ultrasound (LUS) has emerged as a promising tool for assessing hydration, although pediatric data are limited.
Methods:
We conducted a retrospective, single-center study between January and September 2024. Target weight was assessed using clinical examination, pre-dialysis NT-proBNP level, relative overhydration by bioimpedance analysis (BIA), inferior vena cava (IVC) diameter, and LUS score (12-zone protocol). The primary outcome was the association between LUS and other assessment methods. Secondary outcomes included the reliability of LUS with dialysis-related weight loss and its contribution to multimodal evaluation. Mixed-effects regression models were used.
Results:
Sixty-eight dialysis sessions of 10 children on hemodialysis were analyzed. The median pre-dialysis LUS score was 7 (IQR 5-9), which decreased to 4 (IQR 3-6) post-dialysis. LUS correlated significantly with NT-proBNP level (p = 0.006) but not with BIA or IVC. A trend was observed for clinical signs (p = 0.072). Changes in the LUS score correlated with dialysis-related weight loss (p < 0.001).
Conclusions:
LUS is a sensitive, dynamic complementary tool for assessing target weight in pediatric hemodialysis patients. It provides additional information on extravascular fluid status and should be considered within multimodal target weight strategies, especially in cases of discordance.
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