LUNG ULTRASOUND GUIDED DRY-WEIGHT REDUCTION DECREASES CARDIAC CHAMBERS DIMENSIONS AND IMPROVES VENTRICULAR DIASTOLIC FUNCTION IN HEMODIALYSIS PATIENTS: LONG-TERM ANALYSIS OF A LUST SUB-STUDY

Abstract Background and Aims Left ventricular hypertrophy (LVH) and dysfunction are highly prevalent in hemodialysis patients and independently associated with adverse outcomes. Few interventions were shown to effectively reduce LVH in hemodialysis. This study examines the long-term effects of dry-weight reduction with a standardized lung-ultrasound-guided strategy on echocardiographic indices of left and right cardiac chambers in hemodialysis patients. Method This is the report of the 12-month trial phase of a randomized controlled trial in 71 clinically euvolemic, hemodialysis patients with hypertension. Patients were randomized (1:1 ratio) in the active group (23 male and 12 female), following dry-weight reduction guided by the total number of US-B lines prior to a mid-week dialysis session and the control group (24 male and 12 female), following standard-of-care treatment. Among several assessments, participants underwent two-dimensional and tissue-Doppler echocardiographic (TDI) at baseline and study-end. Results During follow-up dry-weight reduction took place in more patients in the active compared with the control group (71.4% vs 22.2%; p<0.001). Left atrial (LA) surface (-1.37±4.50 vs 1.28±5.00 cm2; P=0.006) and LA volume index (-3.22±11.82 vs 4.76±12.83 ml/m2; P=0.009) decreased in the active and increased in the usual-care group. Left ventricle (LV) diastolic (-0.94±11.45 vs 6.58±13.92 ml/m2; P=0.015) and systolic (-0.89±7.11 vs 3.38±7.89 ml/m2; P=0.018) volume index decreased only in the active group. LV mass index slightly decreased in the active (134.21±44.75 vs 133.57±45.51; P=0.844) and was marginally increased in the control group (134.21±40.96 vs 143.77±50.04 g/m2; P=0.089). Right ventricular (RV) systolic pressure was stable in the active (23.74±13.76 vs 24.35±12.99; P= 0.795) and significantly increased in the usual-care group (26.24±12.95 vs 31.20±16.13 mmHg; P=0.028). Reductions in LV A wave were greater in the active compared to the usual-care group (-4.98±15.11 vs 2.23±21.71 m/s; P=0.009). Changes in LV systolic and RV diastolic function indices were not different between the two groups. Conclusion Over 12 months, a lung-ultrasound-guided strategy for dry-weight reduction can effectively decrease cardiac chamber dimensions, prevent LVMi increase and improve LV diastolic and RV systolic function.