1. A randomized multicenter trial on a lung ultrasound-guided treatment strategy in patients on chronic hemodialysis with high cardiovascular risk
- Author
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Thierry Hannedouche, Giovanni Tripepi, Olga Balafa, Aikaterini Papagianni, Carmine Zoccali, Radovan Hojs, Claudia Torino, Rosa Sicari, Luna Gargani, Itzchak Slotki, Linda Shavit, Alberto Martínez-Castelao, Alexandre Seidowsky, Francesca Mallamaci, Krzysztof Letachowicz, Enrico Fiaccadori, Dimitrie Siriopol, Yuri Battaglia, Ziad A. Massy, Patrick Rossignol, Gérard M. London, Friedo W. Dekker, Kostas C. Siamopoulos, Pantelis Sarafidis, Robert Ekart, Thomas Bachelet, Kitty J. Jager, Adrian Covic, Giuseppe Regolisti, Marie-Jeanne Coudert-Krier, Aristeidis Stavroulopoulos, Andrzej Wiecek, Sarah Seiler-Mußler, Fabio Lizzi, Rocco Tripepi, Danilo Fliser, Carolina Polo-Torcal, Marian Klinger, Agata Miskiewicz, Eugenio Picano, Medical Informatics, ACS - Pulmonary hypertension & thrombosis, APH - Aging & Later Life, APH - Quality of Care, and APH - Global Health
- Subjects
cardiovascular risk ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,lung congestion ,law.invention ,Kidney Failure ,Randomized controlled trial ,Renal Dialysis ,Risk Factors ,law ,Multicenter trial ,Internal medicine ,Humans ,Medicine ,Chronic ,Risk factor ,ESRD ,education ,Lung ,Ultrasonography, Interventional ,Dialysis ,Ultrasonography ,lung ultrasound ,education.field_of_study ,Interventional ,business.industry ,Hazard ratio ,chronic kidney failure ,medicine.disease ,heart failure hemodialysis ,Heart Disease Risk Factors ,Cardiovascular Diseases ,Nephrology ,Heart failure ,Quality of Life ,Kidney Failure, Chronic ,Hemodialysis ,business - Abstract
Lung congestion is a risk factor for all-cause and cardiovascular mortality in patients on chronic hemodialysis, and its estimation by ultrasound may be useful to guide ultrafiltration and drug therapy in this population. In an international, multi-center randomized controlled trial (NCT02310061) we investigated whether a lung ultrasound-guided treatment strategy improved a composite end point (all-cause death, non-fatal myocardial infarction, decompensated heart failure) vs usual care in patients receiving chronic hemodialysis with high cardiovascular risk. Patient-Reported Outcomes (Depression and the Standard Form 36 Quality of Life Questionnaire, SF36) were assessed as secondary outcomes. A total of 367 patients were enrolled: 183 in the active arm and 180 in the control arm. In the active arm, the pre-dialysis lung scan was used to titrate ultrafiltration during dialysis and drug treatment. Three hundred and seven patients completed the study: 152 in the active arm and 155 in the control arm. During a mean follow-up of 1.49 years, lung congestion was significantly more frequently relieved in the active (78%) than in the control (56%) arm and the intervention was safe. The primary composite end point did not significantly differ between the two study arms (Hazard Ratio 0.88; 95% Confidence Interval: 0.63-1.24). The risk for all-cause and cardiovascular hospitalization and the changes of left ventricular mass and function did not differ among the two groups. A post hoc analysis for recurrent episodes of decompensated heart failure (0.37; 0.15-0.93) and cardiovascular events (0.63; 0.41-0.97) showed a risk reduction for these outcomes in the active arm. There were no differences in patient-reported outcomes between groups. Thus, in patients on chronic hemodialysis with high cardiovascular risk, a treatment strategy guided by lung ultrasound effectively relieved lung congestion but was not more effective than usual care in improving the primary or secondary end points of the trial.
- Published
- 2021