# Longechogeleide behandeling bij hemodialysepatiënten met hoog CV-risico: gerandomiseerde trial

*geplaatst 2021-12-01 · Preventie · Kidney international · doi 10.1016/j.kint.2021.07.024 · https://hartvaat.nl/2021/12/01/longechogeleide-behandeling-bij-hemodialysepatienten-met-hoog-cv-risico-gerandom/*

Gerandomiseerde multicenter trial van longechogeleide behandelstrategie bij chronische hemodialysepatiënten met hoog cardiovasculair risico.

## English: A randomized multicenter trial on a lung ultrasound-guided treatment strategy in patients on chronic hemodialysis with high cardiovascular risk.

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.

## Abstract (original, from the publication)

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.

Auteurs: 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

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Bron: Kidney international, https://doi.org/10.1016/j.kint.2021.07.024. Bijgewerkt 2026-07-03T13:28:38Z. 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.