Zoccali C, Torino C, Mallamaci F, et al. - A treatment strategy guided by lung ultrasound affords an effective solution to relieve lung congestion in chronic hemodialysis patients with high cardiovascular risk but failed to show greater effectiveness than usual care in improving the primary or secondary endpoints of the trial.

• Lung congestion confers risk for all-cause and cardiovascular mortality in chronic hemodialysis patients.

• This is an international, multi-center randomized controlled trial with patients on chronic hemodialysis with high cardiovascular risk.

• Patients were assigned to active and control arms; in the active arm, pre-dialysis lung scan was used to titrate ultrafiltration during dialysis and drug treatment.

• Composite endpoint included all-cause death, non-fatal myocardial infarction, decompensated heart failure, and secondary endpoint included patient-reported outcomes.

• Relief in lung congestion occurred significantly more frequently in the active (78%) vs in the control (56%) arm and safety of the intervention was evident.

• No significant difference in primary composite endpoint was observed between the two study arms (Hazard Ratio 0.88).

• A post hoc analysis revealed risk reduction for recurrent episodes of decompensated heart failure and cardiovascular events in the active arm.

• Patient-reported outcomes did not differ between groups.