A randomized multicenter trial on a lung ultrasound–guided treatment strategy in patients on chronic hemodialysis with high cardiovascular risk

• Published in: Kidney international Vol. 100; no. 6; pp. 1325 - 1333
• Main Authors: Zoccali, Carmine, Torino, Claudia, Mallamaci, Francesca, Sarafidis, Pantelis, Papagianni, Aikaterini, Ekart, Robert, Hojs, Radovan, Klinger, Marian, Letachowicz, Krzysztof, Fliser, Danilo, Seiler-Mußler, Sarah, Lizzi, Fabio, Wiecek, Andrzej, Miskiewicz, Agata, Siamopoulos, Kostas, Balafa, Olga, Slotki, Itzchak, Shavit, Linda, Stavroulopoulos, Aristeidis, Covic, Adrian, Siriopol, Dimitrie, Massy, Ziad A., Seidowsky, Alexandre, Battaglia, Yuri, Martinez-Castelao, Alberto, Polo-Torcal, Carolina, Coudert-Krier, Marie-Jeanne, Rossignol, Patrick, Fiaccadori, Enrico, Regolisti, Giuseppe, Hannedouche, Thierry, Bachelet, Thomas, Jager, Kitty J., Dekker, Friedo W., Tripepi, Rocco, Tripepi, Giovanni, Gargani, Luna, Sicari, Rosa, Picano, Eugenio, London, Gérard Michel
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2021
• Subjects: Cardiovascular Diseases - diagnostic imaging; cardiovascular risk; chronic kidney failure; ESRD; Heart Disease Risk Factors; heart failure hemodialysis; Humans; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Lung - diagnostic imaging; lung congestion; lung ultrasound; Quality of Life; Renal Dialysis - adverse effects; Risk Factors; Ultrasonography, Interventional; ESRD; heart failure hemodialysis; lung congestion; cardiovascular risk; chronic kidney failure; lung ultrasound
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1016/j.kint.2021.07.024

Lung congestion is a risk factor for all-cause and cardiovascular mortality in patients on chronic hemodialysis, and its estimation by ultrasound may be useful to guide ultrafiltration and drug therapy in this population. In an international, multi-center randomized controlled trial (NCT02310061) we investigated whether a lung ultrasound-guided treatment strategy improved a composite end point (all-cause death, non-fatal myocardial infarction, decompensated heart failure) vs usual care in patients receiving chronic hemodialysis with high cardiovascular risk. Patient-Reported Outcomes (Depression and the Standard Form 36 Quality of Life Questionnaire, SF36) were assessed as secondary outcomes. A total of 367 patients were enrolled: 183 in the active arm and 180 in the control arm. In the active arm, the pre-dialysis lung scan was used to titrate ultrafiltration during dialysis and drug treatment. Three hundred and seven patients completed the study: 152 in the active arm and 155 in the control arm. During a mean follow-up of 1.49 years, lung congestion was significantly more frequently relieved in the active (78%) than in the control (56%) arm and the intervention was safe. The primary composite end point did not significantly differ between the two study arms (Hazard Ratio 0.88; 95% Confidence Interval: 0.63-1.24). The risk for all-cause and cardiovascular hospitalization and the changes of left ventricular mass and function did not differ among the two groups. A post hoc analysis for recurrent episodes of decompensated heart failure (0.37; 0.15-0.93) and cardiovascular events (0.63; 0.41-0.97) showed a risk reduction for these outcomes in the active arm. There were no differences in patient-reported outcomes between groups. Thus, in patients on chronic hemodialysis with high cardiovascular risk, a treatment strategy guided by lung ultrasound effectively relieved lung congestion but was not more effective than usual care in improving the primary or secondary end points of the trial. [Display omitted]