Evaluation of abnormal Chest X-rays for hemodialysis patients

Abstract

Background: A chest x-ray is the most practical way to evaluate lung disease. There are different degrees of pulmonary abnormalities in hemodialysis patients. The diagnosis of pulmonary disease in hemodialysis patients can be challenging due to the complex findings and multiple manifestations. Objective: This study aimed to identify and evaluate the accuracy and consistency of chest radiographs in the diagnosis of pulmonary abnormalities in hemodialysis patients, Also highlight the limitations of CXR for diagnoses. Materials and methods: We collected and reviewed chest radiographs of 60 hemodialysis patients with various pulmonary manifestations. Two experienced radiologists independently interpreted CXR uptake to diagnose pulmonary disease. The degree of incompatibility among radiologists was assessed using SPSS statistical analysis (chi-square test).Results: The two radiologists showed slight agreement in pneumonia (29.6%), pleural effusion (28.6%), pulmonary edema  (25.0%) and cardiomegaly (20.0%). Where the level of disagreement between radiologists 1 and 2 was in cardiomegaly (80.0%), pulmonary edema (75.0%)  ),  pneumonia  (70.4%) and pleural effusion (71.4 %). The total level of agreement was 31.7% and 63.3% disagreement. This result indicates that there is a significant difference in terms of diagnosis (X2 = 8.067,  p-value <0.05).Conclusion: The chest X-ray upon admission is limited in accurately diagnosing pulmonary abnormalities in hemodialysis patients, primarily due to the presence of multiple diseases in the same patient and the increased occurrence of pulmonary edema in these patients. This poses a challenge to diagnosis without clinical data or the utilization of other imaging techniques.