For a study, it was determined that fluid overload was a frequent consequence in patients with chronic kidney disease (CKD), especially in those with renal failure, who were at a high risk of pulmonary edema. Lung ultrasonography was a well-validated tool for estimating lung water in clinical settings. Several investigations in renal failure patients found a high frequency of moderate to severe asymptomatic lung congestion, which was only slightly associated with fluid excess as evaluated by bioimpedance spectroscopy. Furthermore, lung congestion was found to be dose-dependently associated with the risk of mortality in the investigations. In the Lung Water by Ultrasound-Guided Treatment to Prevent Death and Cardiovascular Complications in High-Risk Kidney Failure Patients with Cardiomyopathy (LUST) trial, a treatment strategy guided by lung ultrasound safely relieving lung congestion but failed to significantly reduce the risk for a combined endpoint that included death, nonfatal myocardial infarction, and decompensated heart failure. 

However, in accordance with 3 trials in heart failure patients, a post-hoc analysis of the LUST study found that using lung ultrasonography decreased the risk of recurring episodes of acute heart failure and cardiovascular events. Because of the substantial cardiovascular risk of pulmonary edema in patients with predialysis CKD, identifying the epidemiology of lung congestion in the population as a public health priority. Targeting lung congestion at an asymptomatic stage might improve the poor cardiovascular prognosis of both patients on predialysis and patients on dialysis, according to specific trials in the group and subsequent trials in patients with kidney failure.

Reference:cjasn.asnjournals.org/content/early/2022/02/09/CJN.14591121