31 patients were registered, aged between 27 to 70 years with an average age of 49 years . The first cause of kidney disease was hypertensive nephropathy (32.3%) followed by chronic glomerulonephritis (25.8%) and diabetic nephropathy (19.4%). The major comorbidities of these patients were high blood pressure (83.9%), diabetes (29%), heart failure (16%) and left ventricular hypertrophy (16%).
Variations in clinical and ultrasonographic signs after dialysis
After dialysis it was observed that the number of dyspnoeic patients significantly reduced but more patients complained of cramps (Table II). Up to 42.5% of patients proved to have fluid overload before dialysis whereas 16.1% showed a normal clinical hydration status (Table III)
Table II: Changes in clinical signs after dialysis
Variables
|
|
Number n (%)
|
|
|
Clinical signs
|
Before dialysis
|
After dialysis
|
P value
|
Signs of congestion
|
Peripheral edema
|
6 (19.4)
|
3 (9.7)
|
0.25
|
Dyspnea
|
10 (32.3)
|
2 (6.5)
|
0.008.
|
AP ≥ 140/90 mmHg
|
27 (87.1)
|
22 (71)
|
0.125.
|
Jugular veins turgor
|
16 (51.6)
|
12 (38.7)
|
0.125.
|
Ascites
|
3 (9.7)
|
2 (6.5)
|
1.
|
Signs of hypovolemia
|
Low blood pressure
|
0.
|
1 (3.2)
|
1.
|
Dizziness
|
1 (3.2)
|
6 (19.4)
|
0.063.
|
Cramps
|
0.
|
6 (19.4)
|
0.031.
|
Asthenia
|
0.
|
2 (6.5)
|
0.5.
|
|
|
|
|
|
|
Values are given in frequency and percentage in brackets; significant p values are in bold.
Table III: Hydration status according to clinical score
Clinical score
|
Clinical hydration status
|
Before dialysis n(%)
|
After dialysis n(%)
|
≤ - 3
|
Patent hypovolemia
|
0.
|
1 (3.2)
|
-2
|
Latent hypovolemia
|
1 (3.2)
|
2 (6.5)
|
-1
|
Undefined
|
0.
|
5 (16.1)
|
0
|
Normal
|
0.
|
5 (16.1)
|
1
|
Undefined
|
11 (35.5)
|
8 (25.8)
|
2
|
Latent fluid overload
|
5 (16.1)
|
5 (16.1)
|
≥ 3
|
Patent fluid overload
|
14 (45.2)
|
5 (16.1)
|
Values are given in frequency and percentages in brackets.
Levels of systolic blood pressure and weight decreased considerably after dialysis. Blood pressure decreased from 164.74( 26.50) to 158.48( 27.89) mmHg and weight loss from 74.76( to 71.38( 11.34) kg. It was also observed that clinical score significantly dropped after dialysis (p < 0.001).
B-lines number median reduced considerably after dialysis (p < 0.001), as described in table IV.
Table IV: Changes in the number of B-lines after dialysis
Number of B-lines
|
N (%) before dialysis
|
N (%) after dialysis
|
< 6 = no congestion
|
4 (12.9)
|
8 (25.8)
|
[6-15] = mild congestion
|
15 (48.4)
|
17 (54.8)
|
[16-30] = moderate congestion
|
8 (25.8)
|
6 (19.4)
|
> 30= severe congestion
|
4 (12.9)
|
0.
|
Values are given in frequency and percentage in brackets; lung congestion < 6 B-lines = no congestion, [6-15] = mild congestion, [16-30] = moderate congestion, > 30 = severe congestion.
Factors associated with the number of B-lines
The clinical factors associated with the presence of B-lines before dialysis were dyspnoea and jugular veins turgor. This association decreased after dialysis. Indeed the number of dyspnoeic patients increased with the severity of lung congestion assessed by the number of B-lines (Figure 2). It was the same observation with jugular veins turgor (Figure 3). This number was very low after dialysis.
Correlation between measured parameters and the number of B-lines
We assessed the number of B lines before and after dialysis, the decrease in the number of B lines after dialysis and the various measured clinical parameters.
Clinical parameters associated with the number of B-lines before dialysis:
There was a big correlation between the number of B lines before and after dialysis (r=0.805, p<0.001), measured by the interclass correlation coefficient. The number of B-lines was also associated with the clinical score before dialysis (r=0.549; p=0.001).
Clinical and ultrasonographic parameters associated with the decrease in the number of B lines:
table V show that the decrease in the number of B-lines after dialysis was strongly associated with the number of B lines before dialysis (r = 0.862; p < 0.001).
Table V: Correlation with the reduction of the number of B-lines
Variables
|
Spearman’s rank correlation coefficient
|
P value
|
B1-lines
|
0.862.
|
0.000.
|
∆weight
|
0.061.
|
0.746.
|
B1-lines= number of B-lines before dialysis; ∆weight= change of weight before and after dialysis; significant p values are in bold.
Clinical and sonographical parameters associated with the number of B-lines before dialysis
Findings in table VI show that the number of B-lines after dialysis were strongly correlated with that of B-lines before dialysis (r = 0.935; p < 0.001) and with the reduction of B-lines after dialysis (r = 0.672; p < 0.001).
Table VI: Correlation with the number of B-lines after dialysis
Variables
|
Spearman’s rank correlation coefficient
|
P value
|
B1-lines
|
0.935.
|
0.000.
|
∆B-lines
|
0.672.
|
0.000.
|
Systolic blood pressure
|
0.121.
|
0.515.
|
Diastolic blood pressure
|
-0.084.
|
0.653.
|
Pulses
|
0.157.
|
0.400.
|
SaO2
|
-0.166.
|
0.371.
|
Clinical score 2
|
0.211.
|
0.255.
|
B1-lines = number of B-lines before dialysis, ∆B-lines = decrease in the number of B-lines after dialysis, clinical score 2 = clinical score after dialysis, Sao2 = oxygen saturation; significant p values are in bold.