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Bedside sonographic assessments for predicting predialysis fluid overload in children with end-stage kidney disease

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Abstract

Although the number of studies evaluating methods to predict fluid overload is increasing, the assessment of fluid status in children on dialysis is still fraught with inaccuracies. We aimed to evaluate the predictive capability of lung ultrasounds and the inferior vena cava collapsibility index (cIVC) in predialysis overhydration in children with end-stage kidney disease. Ten children with end-stage kidney disease who were on an intermittent hemodialysis program were included. The hydration status of the patients was clinically evaluated. Moreover, 30 predialysis and 30 postdialysis lung ultrasound, cIVC, and bioimpedance spectroscopy (BIS) measurements were performed. The median age of the participants was 14 (IQR, 13–15) years, and two (20%) were male. There was a strong positive correlation between the predialysis total number of B-lines and predialysis fluid overload (r=0.764, p<0.001). Additionally, there was a moderate negative correlation between predialysis cIVC and predialysis fluid overload (r=−0.599, p=0.002). Although the moderate correlation was determined between the postdialysis fluid overload and total number of B-lines, no correlation was determined using cIVC. Receiver operating characteristic curves demonstrated that the total number of B-lines and cIVC could successfully predict the predialysis fluid overload (relative hydration >7% derived from the BIS; AUROC 0.82 and 0.80, respectively). When both evaluations were combined, if either the total number of B-lines or the cIVC was outside the corresponding cutoff range (>10.5 and ≤23.5, respectively), it was detected in 16 out of 17 sessions (sensitivity 94%). If either one was outside the corresponding cutoff range (total number of B-lines >10.5 and cIVC ≤18.2), the severe predialysis fluid overload was predicted successfully in all eight (100%) sessions.

Conclusion: Randomized controlled studies are needed to prove the reliability of the combined use of lung ultrasounds and cIVC in the assessment of predialysis fluid overload.

What is Known:

• The association of chronic fluid overload with increased morbidity and mortality raises the need for optimal determination of fluid overload in pediatric patients who are dialysis-dependent at a young age.

• The linear correlation between the total number of B-lines on lung ultrasound images and fluid overload by weight has been shown.

What is New:

• This study evaluates the lung ultrasound and inferior vena cava collapsibility index combined in predicting fluid overload in dialytic children.

• If either the total number of B-lines or the cIVC was outside the corresponding cutoff range (>10.5 and cIVC ≤18.2, respectively), the severe predialysis fluid overload was predicted successfully in all eight (100%) sessions.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

N/A

Abbreviations

AUROC:

Area under the ROC curve

BIA:

Bioimpedance analysis

cIVC:

Inferior vena cava collapsibility index

ESKD:

End-stage kidney disease

IVC:

Inferior vena cava

NT-proBNP:

N-terminal pro-brain natriuretic peptide

RH:

Relative hydration

ROC:

Receiver operating characteristic

UF:

Ultrafiltration

USG:

Ultrasonography

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Authors and Affiliations

  1. Faculty of Medicine, Division of Pediatric Intensive Care Unit, Çukurova University, Sarıçam, Adana, Turkey

    Ahmet Yontem, Dincer Yildizdas, Ozden Ozgur Horoz & Faruk Ekinci

  2. Faculty of Medicine, Division of Pediatric Nephrology, Çukurova University, Sarıçam, Adana, Turkey

    Cagla Cagli, Bahriye Atmis & Aysun Karabay Bayazit

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  1. Ahmet Yontem
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  2. Cagla Cagli
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Contributions

Conceptualization: AY, DY, AKB. Methodology: FE, BA. Data curation: AY, CC. Formal analysis and investigation: AY, FE, BA, OOH. Writing—original draft preparation: AY, CC. Writing—review and editing: DY, OOH, AKB. Resources: OOH, AY, FE, BA. Supervision: DY, AKB.

Corresponding author

Correspondence to Ahmet Yontem.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Çukurova University Faculty of Medicine Non-Interventional Clinical Research Ethics Committee.

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Informed consent was obtained from legal guardians to participate.

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Informed consent was obtained from legal guardians for publication.

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The authors declare no competing interests.

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Communicated by Gregorio Paolo Milani

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Supplementary Information

ESM 1

Bland-Altman analysis comparing fluid overload assessed by clinical evaluation and by bioimpedance spectroscopy analysis (PDF 21 kb).

ESM 2

Different cutoff values for the total number of B-lines and cIVC according to overhydration severity (PDF 277 kb).

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Yontem, A., Cagli, C., Yildizdas, D. et al. Bedside sonographic assessments for predicting predialysis fluid overload in children with end-stage kidney disease. Eur J Pediatr 180, 3191–3200 (2021). https://doi.org/10.1007/s00431-021-04086-z

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  • DOI: https://doi.org/10.1007/s00431-021-04086-z

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