6533b830fe1ef96bd129677c

RESEARCH PRODUCT

Inflammation is an amplifier of lung congestion by high lv filling pressure in hemodialysis patients: a longitudinal study

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Introduction Since infammation alters vascular permeability, including vascular permeability in the lung, we hypothesized that it can be an amplifer of lung congestion in a category of patients at high risk for pulmonary oedema like end stage kidney disease (ESKD) patients. Objective and methods We investigated the efect modifcation by systemic infammation (serum CRP) on the relationship between a surrogate of the flling pressure of the LV [left atrial volume indexed to the body surface area (LAVI)] and lung water in a series of 220 ESKD patients. Lung water was quantifed by the number of ultrasound B lines (US-B) on lung US. Six-hundred and three recordings were performed during a 2-year follow up. Longitudinal data analysis was made by the Mixed Linear Model. Results At baseline, 88 had absent, 101 had mild to moderate lung congestion and 31 severe congestion. The number of US B lines associated with LAVI (r=0.23, P<0.001) and serum CRP was a robust modifer of this relationship (P<0.001). Similarly, in fully adjusted longitudinal analyses US-B lines associated with simultaneous estimates of LAVI (P =0.002) and again CRP was a strong modifer of this relationship in adjusted analyses (P≤0.01). Overall, at comparable LAVI levels, lung congestion was more pronounced in infamed than in non-infamed patients. Conclusion In ESKD systemic infammation is a modifer of the relationship between LAVI, an integrate measure of LV flling pressure, and lung water. For any given pressure, lung water is increased with higher CRP levels, likely refecting a higher permeability of the alveolar-capillary barrier.