{"id":"3e5fe10ff859","type":"article","url":"https://hartvaat.nl/2021/12/01/longechogeleide-behandeling-bij-hemodialysepatienten-met-hoog-cv-risico-gerandom/","title":"Longechogeleide behandeling bij hemodialysepatiënten met hoog CV-risico: gerandomiseerde trial","title_en":"A randomized multicenter trial on a lung ultrasound-guided treatment strategy in patients on chronic hemodialysis with high cardiovascular risk.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"Kidney international","doi":"10.1016/j.kint.2021.07.024","source_url":"https://doi.org/10.1016/j.kint.2021.07.024","authors":["Carmine Zoccali","Claudia Torino","Francesca Mallamaci","Pantelis Sarafidis","Aikaterini Papagianni","Robert Ekart","Radovan Hojs","Marian Klinger","Krzysztof Letachowicz","Danilo Fliser","Sarah Seiler-Mußler","Fabio Lizzi","Andrzej Wiecek","Agata Miskiewicz","Kostas Siamopoulos","Olga Balafa","Itzchak Slotki","Linda Shavit","Aristeidis Stavroulopoulos","Adrian Covic","Dimitrie Siriopol","Ziad A Massy","Alexandre Seidowsky","Yuri Battaglia","Alberto Martinez-Castelao","Carolina Polo-Torcal","Marie-Jeanne Coudert-Krier","Patrick Rossignol","Enrico Fiaccadori","Giuseppe Regolisti","Thierry Hannedouche","Thomas Bachelet","Kitty J Jager","Friedo W Dekker","Rocco Tripepi","Giovanni Tripepi","Luna Gargani","Rosa Sicari","Eugenio Picano","Gérard Michel London"],"significance":6,"published":"2021-12-01","source_date":"2021-12-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This randomized multicenter trial showed that lung ultrasound-guided treatment in chronic hemodialysis patients with high cardiovascular risk reduces pulmonary congestion, testing a practical imaging strategy for fluid management.","created":"2026-07-03T10:29:30Z","updated":"2026-07-03T13:28:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde multicenter trial van longechogeleide behandelstrategie bij chronische hemodialysepatiënten met hoog cardiovasculair risico.","abstract_original":"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."}