Lung Ultrasound–Guided Dry Weight Assessment and Echocardiographic Measures in Hypertensive Hemodialysis Patients: A Randomized Controlled Study

Rationale & Objective Left ventricular (LV) hypertrophy and dysfunction are associated with adverse outcomes in hemodialysis patients. Hypertension and hypervolemia play important roles in these cardiac abnormalities. We report on the prespecified secondary outcome, echocardiographic indexes of LV function, from a previously reported study of the effect of lung ultrasound (US)-guided dry weight reduction on systolic blood pressure. Study Design Single-blind randomized trial. Settings & Participants 71 clinically euvolemic hypertensive hemodialysis patients in Greece and Slovenia. Intervention The active intervention group’s (n = 35) volume removal was guided by the total number of lung US B-lines observed every week before a midweek dialysis session. The usual-care group (n = 36) was treated using standard-of-care processes that did not include acquisition of US data. Outcomes 2-dimensional and tissue Doppler echocardiographic indexes at baseline and study end (8 weeks) that evaluated left and right heart chamber sizes, as well as systolic and diastolic function. Results Overall, 19 (54%) patients in the active intervention and 5 (14%) in the usual-care group had ultrafiltration intensification (P  Limitations Exploratory study; small sample size. Conclusions A US-guided strategy for dry weight reduction is associated with decreased cardiac chamber dimensions and LV filling pressure, but no difference in systolic performance compared with usual care in hypertensive hemodialysis patients. Funding European Renal Association–European Dialysis and Transplant Association. Trial Registration Registered at ClinicalTrials.gov with study number NCT03058874 .