Pediatr Nephrol. 2025 Nov 25. doi: 10.1007/s00467-025-07068-7. Online ahead of print.
ABSTRACT
BACKGROUND: B-line quantification by lung ultrasonography (LUS) is a non-invasive method to assess pulmonary edema and fluid overload. This study evaluated the change in the number of B-lines on LUS and its correlation with ultrafiltration (UF) volume after acute intermittent hemodialysis sessions, in children with AKI, along with the inferior vena cava collapsibility index (IVCCI), weight changes, and blood pressure parameters.
METHODS: In this prospective observational study, children with AKI undergoing hemodialysis were included. Fluid overload was assessed using an 8-zone LUS protocol, IVCCI measurements, blood pressure, and weight changes pre- and post-hemodialysis sessions. Correlations between changes in B-lines with UF volume, IVCCI, weight, and blood pressure were analyzed. A p-value of <0.05 was considered significant.
RESULTS: A total of 60 hemodialysis sessions in 17 children with AKI (mean age 9.32 ± 3.70 years, n = 17, 52.9% male) were studied. Significant reductions were observed in B-lines post-hemodialysis (24.65 ± 9.21 to 11.92 ± 5.62, p < 0.001), correlating strongly with UF volume (r = 0.588, p < 0.001). IVCCI increased significantly post dialysis (26.68 ± 7.29% to 40.13 ± 6.50%, p < 0.001) and showed a moderate correlation with B-line reduction (r = 0.264, p = 0.041). The median weight decreased significantly from 25.61 kg (IQR 18.45-39.14) pre-dialysis to 24.25 kg (IQR 17.96-37.71) post-dialysis (p < 0.001), correlating with B-line reduction (r = 0.41, p = 0.008).
CONCLUSIONS: Significant correlations of change in B-lines on LUS with UF volume, IVCCI, and weight changes in children with AKI undergoing acute intermittent hemodialysis support its integration into routine clinical practice to guide precise fluid removal and mitigate complications.
PMID:41291256 | DOI:10.1007/s00467-025-07068-7
