#4877 THE EFFECT OF NURSE-LED 8-ZONE LUNG ULTRASOUND GUIDED TITRATION OF DRY WEIGHT ON HYPERTENSION IN APPARENTLY EUVOLAEMIC HAEMODIALYSIS PATIENTS

Abstract Background and Aims Hypertension related to subclinical volume overload is a common clinical problem in hemodialysis patients. Lung ultrasound (LUS) validated technique for minute titration of dry weight, but has limited adoption practice because it currently physician (nephrologist)-led methodology time consuming with 24-lung zones needing be imaged. This study aims show that (1) simplified 8-zone LUS protocol effective at weight clinically euvolaemic chronic haemodialysis patients, as determined by 24-hour ambulatory blood pressure monitoring (ABPM), (2) nurse-led feasible safe. Method was 6-week pre post intervention 13 euvolemic patients hypertension. 4 senior dialysis nurses least years nursing experience respectively were trained image acquisition interpretation via 1 day workshop certified Nephrologist passed an test. (which been described Volpicelli et al.[1]) performed midweek, weekly. A reviewed all the acquired images retrospectively. Dry titrated down rate not exceeding 0.3 kg per week if Kerley B lines exceeded 3 any lung zone. All underwent ABPM baseline after 6 weeks. Nurses qualitative survey elucidate success factors confidence technique. Results The cohort predominantly male (69%) diabetic (92%), average age 68 ± 10 years. required nurse complete scan 0.4 minutes. 75% had reduction post-study, which ranged from 0.08 – 0.9% initial weight. Correspondingly, median number ultrasonographic B-lines reduced 3, although this did reach statistical significance. Overall, there reductions systolic BP (146.42±17.03 vs 139.08±12.40 mmHg; p = 0.067) diastolic (72.75±11.79 70.75±11.69 0.561). Similarly, trends towards improvements pre- post-dialysis BPs, only pre-dialysis BPs showed statistically significant improvement (80±16.05 72.33±13.32 mmHg, 0.046). may small sample size. Nil adverse outcomes such intra-dialytic hypotension, vascular thrombosis, cardiovascular events or fluid reported during study. patient demised pneumonia sepsis, deemed unrelated expressed following workshop. Their further bolstered end They also felt point-of-care useful skill experienced who often responsible adjustment removal on dialysis. Conclusion We have demonstrated can effectively safely titrate evidenced 24-hours ABPM. Importantly, these results are similar randomized controlled trials LUST where physician-led. There remains little doubt about importance assessment. In-depth studies determine competencies of, risk-benefit assessment LUS, improve relevance penetrance tool.