| Background:As of 2020,the number of maintenance hemodialysis(MHD)patients in China has exceeded690,000.Abnormal fluid volume overload is one of the most common complications of MHD patients.Long-term chronic fluid volume overload will increase the preload of the heart,thereby affecting the quality of life and time of MHD patients.Abnormal fluid volume status in MHD patients is also a common problem encountered by nephrologists in their clinical work.A gold standard suitable for accurate assessment of fluid volume status in MHD patients has not yet been found.The clinical indicators that can be used to measure the fluid volume status of MHD patients include ultrasound measurement of inferior vena cava diameter(IVCD),biomarkers,Bioelectrical impedance analysis(BIA),and chest X-ray measurement Cardiothoracic length ratio,Lung Ultrasound(LUS),etc.BIA is the most commonly used method to measure the fluid volume status of MHD patients in clinical practice,and body composition monitor(BCM)is one of the most commonly used BIA versions in clinical practice.A biomarker that can be used to assess fluid volume in MHD patients is NT-proBNP.Lung ultrasound is a technology that has just been developed in recent years.The use of ultrasound to detect MHD chest produces a comet tail sign,also known as B-line,which mainly evaluates the fluid outside the lungs of patients,and then evaluates the fluid volume status of MHD patients.In this study,based on BCM,the fluid volume status of MHD patients was assessed by lung ultrasound combined with NT-proBNP,and the relationship between the two in assessing the fluid volume status of MHD patients was studied.Provides a fast and convenient measurement method.Objective:To evaluate the value of new technology lung ultrasound in assessing fluid volume status in MHD patients,and to study the relationship between lung ultrasound combined with NT-proBNP in assessing fluid volume in MHD patients.To provide nephrologists with a simpler,faster and more convenient technical method for evaluating the fluid volume status of MHD patients,so as to keep the fluid volume status of MHD patients within a reasonable range and improve the quality of dialysis.Methods:The subjects of the study were patients who received hemodialysis at the Blood Purification Center of Henan Provincial People’s Hospital from October 2020 to October 2021.According to the inclusion criteria,a total of 50 patients were included,and 46 patients finally completed the study.The basic information,dialysis-related data and biochemical data of the patients were collected,including blood routine,liver and kidney function and electrolytes before dialysis.Record NT-proBNP,blood pressure,B line number measured by lung ultrasound before and after dialysis,and the body fluid content measured by BCM: intracellular water(ICW),extracellular water(ECW),systemic fluid(Total body water(TBW),and excess extracellular fluid(Overhydration,OH).10 patients were randomly selected,and intra-class correlation coefficient(ICC)was used to evaluate the consistency of the results obtained by trained nephrologists and sonographers in using lung ultrasound,and correlation analysis was used to compare the B line and each fluid content before dialysis.,NT-proBNP,blood pressure,the relationship between dialysis-related data and laboratory indicators,and the relationship between B line,each fluid content,and NT-proBNP after full dialysis.Taking △OH≤1(△OH = OH-interdialysis weight gain)as the standard,the ROC curve was used to evaluate the diagnostic performance of lung ultrasound,NT-proBNP and the combination of the two,and the area under the curve(AUC)was accurate to evaluate the diagnosis.sex.Survival analysis of lung ultrasound,NT-proBNP was performed using Kaplan-Meier curves.Results:1.The B line of 46 patients after dialysis was significantly lower than that before dialysis(t=10.61,P<0.001).TBW,ECW,ICW and OH after dialysis were significantly lower than those before dialysis,among which ICW was(t=8.48,P<0.001),ECW was(t=7.78,P<0.01),and TBW was(t=7.52,P<0.01),OH is(t=10.94,P<0.01).NT-proBNP after dialysis was significantly lower than that before dialysis(Z=-5.91,P<0.001).The blood pressure after dialysis was lower than that after dialysis(t=24.39,P<0.001;t=9.73,P<0.001).2.A total of 10 dialysis patients were randomly selected for lung ultrasound examination before and after dialysis by ultrasonologist and nephrologist respectively,both of whom were unaware of the patient’s condition and the measurement results of each other.The B lines were 17.10±5.82 before dialysis and 7.20±3.83 after dialysis,and 16.35±5.85 before dialysis and 6.80±3.80 after dialysis were measured by ultrasound physicians.The consistency between the two subjects was evaluated by intra-class correlation coefficient(ICC).Analysis showed that ultrasound physicians and trained nephrologists had high reliability in evaluating the number of B line before and after dialysis(ICC=0.96,P< 0.01).3.Before dialysis,the number of B lines,OH,NT-proBNP had no correlation with blood pressure,hemoglobin,albumin,calcium and phosphorus,but there was a strong correlation between B lines and OH(r=0.82,P<0.001),linear regression Equation: Y = 7.015X-3.061.Line B was correlated with NT-proBNP(r=0.75,P<0.001).OH was correlated with NT-proBNP(r=0.64,P<0.001),linear regression equation: Y =1860X + 2619.After dialysis,B line was correlated with OH(r=0.77,P<0.001),B line was correlated with NT-proBNP(r=0.69,P<0.001),OH was correlated with NT-proBNP(r=0.60,P<0.001).4.Taking △OH≤1 after dialysis as the standard of dry body weight,46 patients were divided into two groups.In the two groups,23 people in the normal load group and 23 people in the overload group reached 50% of the standard dry weight,and the B line in the overload group was higher than that in the normal load group(t=4.544,P<0.001).The NT-proBNP in the overload group was significantly higher than that in the normal overload group(t=2.831,P<0.001),the weight gain during interdialysis in the overload group was higher than that in the normal overload group(t=3.592,P=0.002),and the excess cells in the overload group External fluid(OH)was higher than the normal load group(t=3.528,P=0.002),and the weight gain during dialysis in the overload group was higher than that in the normal load group(t=2.098,P=0.048).There were no differences in gender,age,dialysis age,ICW,ECW,TBW,blood pressure,hemoglobin,albumin,calcium,and phosphorus between the two groups.ROC curve analysis showed that the AUC of lung ultrasound in evaluating the volume load status of dialysis patients was 0.841,(95%CI: 0.728-0.954,P<0.05),the best cut-off value of B line was 16.5,the sensitivity was 82.6%,and the specificity was 82.6%.was 73.9%.The AUC of NT-proBNP for evaluating the volume loading status of dialysis patients was 0.808,(95%CI: 0.681-0.935,P< 0.05),the optimal critical value was 4375ng/L,the sensitivity was 87%,and the specificity was 65.2%.The AUC of combined lung ultrasound and NT-proBNP to evaluate the volume load status of dialysis patients was 0.890,(95%CI: 0.798-0.983,P<0.05),with a sensitivity of 91.3% and a specificity of 78.3%.5.46 patients were followed up for 6 months after completion of the examination,during which 7died.According to the optimal threshold of the number of B lines was only 16.5,the 46 patients were divided into two groups: mild and severe.1 died in the mild stress group.There were 6 died in the heavily stressed group.The Kaplan-Meier curve was used to show that the survival time of the mild stress group was higher than that of the severe stress group,and there was a statistical difference between the two groups(Log-rank test,χ2 =4.431,P=0.038).According to the optimal cutoff line of NT-proBNP of4375ng/L,we divided 46 patients into two groups,of which 1 died in the mild stress group and 6 died in the severe stress group.Kaplan-Meier curve analysis showed that the survival time of the mild stress group was higher than that of the severe stress group,and there was a statistical difference between the two groups(Log-rank test,χ2=4.070,P=0.044).Conclusions:1.Lung ultrasound is a fast and convenient method to detect the fluid volume status of dialysis patients.Trained nephrologists can use lung ultrasound to assess the fluid volume status of dialysis patients.2.Lung ultrasound,NT-proBNP and body composition analysis have a good correlation between the evaluation of fluid volume status of dialysis patients,and the combined detection of lung ultrasound and NT-proBNP helps to more accurately evaluate the fluid volume status of dialysis patients.3.Lung ultrasound and NT-proBNP can predict the prognosis of dialysis patients to a certain extent. |
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