Accumulation of water in the lungs (lungcongestion) is a common condition in hemodialysis patients, particularly in those at high cardiovascular risk, like those presenting coronary artery disease and/or heart failure. This alteration can be detected in an X-ray image, but cannot be heard easily with a stethoscope. When the congestion becomes so severe that fluid floods the alveoli (‘alveolar pulmonary edema’), the sound of rattling breathing can be heard (and without a stethoscope at a later stage). Then, at the latest, pulmonary gas exchange is severely impaired, and the patients experience shortness of breath or even fear of death.
