Measurement of Extravascular Lung Water in Hemodialysis Patients Using Blood Ultrasound Velocity and Optical Density Dilution

Abstract

In hemodialysis patients, volume homeostasis is an important clinical problem. The aim is to have patients at an ideal "dry weight" postdialysis, but current methods for accurately measuring dry weight are disappointing. Krivitski et al. (ASAIO J 1998;44:M535-M540) have described a novel technique whereby extravascular lung water (EVLW) may be measured using blood ultrasound velocity and electrical impedance dilution. They have tested this method in animals and achieved agreement between obtained versus gravimetric measurements. Isotonic saline is used as a nondiffusible indicator and hypertonic (5%) saline is used as a diffusible indicator. By injecting these solutions and following their transits through the cardiopulmonary circulation, a theoretic basis for the calculation of EVLW may be derived from the cardiac output, the water transferred to blood, the amount of sodium chloride moved from blood to lung, and the increase in blood osmolality measured at the moment of osmotic equilibrium. We have used this new technique to measure EVLW for the first time in humans in 18 stable hemodialysis patients with no cardiac problems. Measurements were carried out twice in each patient, the first early in dialysis, the second toward the end of a dialysis session where fluid removal took place. The values for EVLW were 260+/-49 ml early in dialysis and 230+/-48 ml late in dialysis. This fall of 30+/-45 ml was statistically significant (p = 0.011). EVLW normalized to body weight was 3.29+/-1.0 ml/kg early and 3.02+/-1.04 ml/kg late in dialysis, a nonsignificant difference (p - 0.073). The normalized EVLW values are almost identical to those obtained in animals (3.1+/-1.4 ml/kg) by Krivitski et al. (see above). We conclude that this new technique can conveniently and noninvasively give an estimate of EVLW in hemodialysis patients. The clinical value of this measurement has now to be determined.