Comparison of Lung Ultrasound and Other Volumetric Methods in Peritoneal Dialysis Patients
Conditions: Peritoneal Dialysis, Hypervolemia, VEGF Overexpression
Sponsor: Sisli Hamidiye Etfal Training and Research Hospital

 
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Comparison of lung ultrasound and other volumetric methods in peritoneal dialysis patients  
Document Date:  May 1st, 2018 
All peritoneal dialysis patients in the clinic have been invited to the study. Exclusion criteria were 
patients younger than 18 years old, unwilling to participate to the study, immobile patients unable to 
perform tests in the same day, history of PD less than 3 months, the presence of active infection, 
history of lung cancer and/or lung operations. 
All enrolled patients answered the questions about hypervolemia symptoms, had physical and 
laboratory examination, chest radiography, echocardiography, bioelectrical impedance analysis and 
lung ultrasound on the same day. 
This study was approved by local ethics committee. All participants provided informed consent form. 
 
DEMOGRAPHIC CHARACTERISTICS  
Data regarding demographic characteristics, ESRD etiology, past and present medical history was 
taken from patients’ medical files. 
HYPERVOLEMIA SYMPTOMS and PHYSICAL EXAMINATION  
Patients were asked for orthopnea, dyspnea at rest, effort dyspnea, paroxysmal nocturnal dyspnea. 
They had a physical examination including height, weight, blood pressure measurement, the definition 
of New York Heart Association (NYHA) class, the presence of third heart sound (S3), crackles, 
pretibial edema. Edema was classified as present or absent.  
LABORATORY  
VEGF-C levels were measured in the serum samples. R&D Systems kit (Minneapolis, MN) (Catalog 
Number DVEC00) was used for the assays according to the user instructions. NT-proBNP was 
measured on the Elecsys 2010 analyzer (Elecsys proBNP Immunoassay; Roche Diagnostics). 

 
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CHEST RADIOGRAPHY  
All radiographs were taken when the patient was standing erect position during deep inhalation. They 
were reported by an expert radiologist blinded to clinical data.  Films taken at a supine position or 
during expirium were excluded. Chest radiographs were classified into 3 stages to reflect a degree of 
hypervolemia [12]. Stage 1 was redistribution defined as an increased artery-to-bronchus ratio in the 
upper and middle lobes. Stage 2 was interstitial edema evident by Kerley B lines and peribronchial 
cuffing. Stage 3 was alveolar edema phase perihilar consolidation and air bronchograms, pleural fluid, 
the increased width of the vascular pedicle, enlarged cardiac silhouette.  
ECHOCARDIOGRAPHY  
Transthoracic echocardiography was performed by the same cardiologist blinded to all other 
parameters.  It was done while the abdomen was empty. LV end diastolic diameter (mm), 
interventricular septum thickness (mm), posterior wall thickness (mm), ejection fraction (%), left 
ventricle end diastolic volume (ml), left atrial volume (ml), left ventricle  mass index (LVMI) 
(g/m2), left ventricle filling velocity(cm/sec), E/E' ratio, pulmonary artery systolic pressure (mm Hg) 
were the parameters taken by echocardiography [13].  
BIOELECTRICAL IMPEDANCE ANALYSIS  
The Body Composition Monitor (BCM) (type 0BJA1394, Fresenius Medical Care AG & Co. KGaA, 
D-61343 Bad Homburg) was used for assessment of hydration status in patients. Peritoneal cavities 
were free of intraperitoneal fluid during measurement [14]. Patients were accepted as normovolemic if 
their result were between -1.1lt and 1.1 lt [15]. 
LUNG ULTRASOUND  
It was performed by 28 area method which contains ultrasound examination from second to fifth 
intercostals spaces at the parasternal region, midclavicular line, anterior and midaxillary lines [16]. 
Lung ultrasound had been done by the same radiologist who was an expertise in ultrasonography 

 
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blinded to all other parameters. It was performed by 1,6 MHz convex probe when a patient lying at the 
supine position. 
STATISTICAL ANALYSIS  
All values were given as a median and interquartile range. Due to the limited number of patients, all 
data were accepted as abnormally distributed. Comparison of continuous variables was performed by 
the Mann Whitney U test and comparison of categorical variables was done by Chi-Square test. 
Correlation analysis was done by Pearson correlation test. P value was accepted as significant if less 
than 0.05. SPSS 21 was used for statistical analysis.