The Diagnostic Value of Lung Ultrasound and Serum Level of Brain Natriuretic Peptide in Asymptomatic Pulmonary Congestion in Pediatric Hemodialysis Patients

Background: Optimising the desired dry weight (DW) to reduce volume overflow in hemodialysis (HD) patients, depending on clinical evaluation, lacks accuracy as signs of hypervolemia are observed only when overhydration is significant.
Objective: To evaluate the diagnostic accuracy of serum level of brain natriuretic peptide (BNP) and its correlation with lung ultrasound (LUS) in detecting the presence of asymptomatic pulmonary congestion as a sign of residual volume overload in HD patient.
Patients and Methods: A prospective observational study was conducted on 20 HD pediatric patients with asymptomatic pulmonary manifestation who underwent LUS and BNP leveling before and after HD session, LUS was considered positive when B-line score (BLS) >10. Volume load parameters were also evaluated before and after HD.
Results: the reduction in mean BNP after HD session was significant as BNP levels reduced from (219.5±67.802) pg/ml to (116.75±50.772) pg/ml, with significant positive correlation between post-dialysis BNP and BLS (p < 0.001, r 0.914).
Conclusion: Many patients who were considered to be at goal DW at the end of the HD session and who were clinically euvolemic with no clinical indications of overhydration, showed lung congestion at LUS. This suggests that even after a patient reaches their supposedly goal DW, they may still be experiencing a residual volume overload. If LUS cannot be used, BNP levelling may be able to help.