None listed
Conditions
Brief summary
Patients on dialysis lack the ability to excrete water adequately and accumulate water in-between dialysis sessions. This excess fluid accumulated needs removal on dialysis. Traditionally the amount of excess fluid accumulated by the patient is estimated by clinical examination. Whilst large fluid excess (volume overload) is relatively easy to detect on clinical examination, it is unreliable for detecting subtle fluid excess. Underestimation of the amount of fluid to be removed on dialysis leads to long term volume overload that results in a number of detrimental effects such as high blood pressure, heart failure and other disorders of the heart and blood vessels that eventually lead to increased mortality. Overestimation of the amount of fluid that needs to be removed on dialysis, results in volume deficit causing post-dialysis fatigue, low blood pressure, dizziness, cramps, seizure and dialysis interruptions that can result in under dialysis. The use of objective measures to supplement the clinical assessment of volume status in dialysis patients is gaining attention. Some of the techniques used have focused on measuring inferior vena cava diameter, bioimpedance and circulating blood volume. These techniques do not convey information on heart function that is critical to patients’ tolerance and response to fluid removal on dialysis. The measure of lung water, the accumulation of which reflects both heart function and the circulating blood volume appear to be much better at identifying patients at risk of adverse volume dependent clinical outcomes and to monitor effects of fluid removal aimed at preventing these adverse outcomes. Recently a quick, simple and easy to learn measure of lung water using ultrasonography has been validated in dialysis patients. The current study aims to assess the feasibility of introducing routine assessment, by the renal unit staff, of volume status in our dialysis patients by measuring their lung water using bedside ultrasonography. We will evaluate the acceptability of the procedure to the operators and patients along with the inter-observer variability. The sensitivity of the ultrasound changes to changes in body weight following dialysis, and the proportion of patients with lung water post-haemodialysis will also be assessed.
Interventions
Lung ultrasound will be performed by novice operators after training and assessment for competence. Novice operators - 2 renal specialists, 2 renal trainees and 2 dialysis nurses with no formal radiology training will be recruited through expression of interest.
The training will involve attending a half-day workshop conducted by Australian Ultrasound Institute and completing a quiz. After this they need to report and submit prescribed number of unsupervised scans recorded as 3-s cine loop for
Lung ultrasound will be performed by novice operators after training and assessment for competence. Novice operators - 2 renal specialists, 2 renal trainees and 2 dialysis nurses with no formal radiology training will be recruited through expression of interest. The training will involve attending a half-day workshop conducted by Australian Ultrasound Institute and completing a quiz. After this they need to report and submit prescribed number of unsupervised scans recorded as 3-s cine loop for assessment by the study radiologist. They will participate in the research only after being deemed competent by the study radiologist. Each participant receives one lung ultrasound scan immediately prior to haemodialysis and a repeat scan immediately post haemodialysis on a single occasion only. Scan of each zone is saved as de-identified 3-s cine loop. All the recorded scans will be blindly reported by the study radiologist.
Sponsors
Gold Coast University Hospital
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Diagnosis
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. On haemodialysis three times a week 2. 18 years or over 3. Ability to consent 4. Have a set target weight 5. Outpatient 6. No clinical evidence of lower respiratory tract infection
Exclusion criteria
Any one not meeting the inclusion criteria
Outcome results
None listed