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

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.

Automated summary

This study evaluated the predictive capability of lung ultrasounds and cIVC in assessing predialysis fluid overload in children with end-stage kidney disease. The results showed that both lung ultrasounds and cIVC could successfully predict fluid overload, especially in the predialysis stage. When combined, these methods had a high predictive accuracy for identifying severe predialysis fluid overload.