Technique can detect congestion before symptoms arise
• Lung ultrasound can detect asymptomatic lung congestion in dialysis patients and can predict their risk of dying prematurely or experiencing heart attacks or other cardiac events.
• Treating asymptomatic lung congestion may help improve cardiovascular health and prevent cardiovascular deaths in dialysis patients.
Lung congestion is highly prevalent and often asymptomatic among patients with kidney failure.
Newswise — Washington, DC (February 28, 2013) — Asymptomatic lung congestion increases dialysis patients’ risks of dying prematurely or experiencing heart attacks or other cardiac events, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The study also found that using lung ultrasound to detect this congestion helps identify patients at risk.
Lung congestion due to fluid accumulation is highly prevalent among kidney failure patients on dialysis, but it often doesn’t cause any symptoms. To see whether such asymptomatic congestion affects dialysis patients’ health, Carmine Zoccali, MD (Ospedali Riuniti, Reggio Calabria, Italy) and his colleagues measured the degree of lung congestion in 392 dialysis patients by using a very simple and inexpensive technique: lung ultrasound.
Among the major findings:
• Lung ultrasound revealed very severe congestion in 14% of patients and moderate-to-severe lung congestion in 45% of patients.
• Among those with moderate-to-severe lung congestion, 71% were asymptomatic.
• Compared with those having mild or no congestion, those with very severe congestion had a 4.2-fold increased risk of dying and a 3.2-fold increased risk of experiencing heart attacks or other cardiac events over a two-year follow-up period.
• Asymptomatic lung congestion detected by lung ultrasound was a better predictor of patients’ risk of dying prematurely or experiencing cardiac events than symptoms of heart failure.
The findings indicate that assessing subclinical pulmonary edema can help determine dialysis patients’ prognoses. “More importantly, our findings generate the hypothesis that targeting subclinical pulmonary congestion may improve cardiovascular health and reduce risk from cardiovascular death in the dialysis population, a population at an extremely high risk,” said Dr. Zoccali. Fluid in the lungs may be reduced with longer and/or more frequent dialysis.
Investigators will soon start a clinical trial that will incorporate lung fluid measurements by ultrasound and will test whether dialysis intensification in patients with asymptomatic lung congestion can prevent premature death and reduce the risk of heart failure and cardiac events.
Study co-authors include Claudia Torino, PhD, Rocco Tripepi, Giovanni Tripepi, PhD, Graziella D’Arrigo, PhD, Maurizio Postorino, MD, Luna Gargani, MD, Rosa Sicari, MD,
Eugenio Picano, MD, PhD, and Francesca Mallamaci, MD, on behalf of the Lung US in CKD Working Group.
Disclosures: The authors reported no financial disclosures.
The article, entitled “Pulmonary Congestion Predicts Cardiac Events and Mortality in ESRD,” will appear online at http://jasn.asnjournals.org/ on February 28, 2013, doi: 10.1681/ASN.2012100990.
The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.
Founded in 1966, and with more than 13,500 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.
# # #