Tonelli Melinda M, Argaiz Eduardo R, Pare Joseph R, Hooker Erika, Kurniawan Helena, Muruganandan Krithika M, Francis Jean M, Jaberi Aala
Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
Emergency Department, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
Cardiorenal Med. 2024;14(1):375-384. doi: 10.1159/000539901. Epub 2024 Jun 19.
Determining ultrafiltration volume in patients undergoing intermittent hemodialysis (IHD) is an essential component in the assessment and management of volume status. Venous excess ultrasound (VExUS) is a novel tool used to quantify the severity of venous congestion at the bedside. Given the high prevalence of pulmonary hypertension in patients with end-stage kidney disease (ESKD), venous Doppler could represent a useful tool to monitor decongestion in these patients.
This is a prospective observational study conducted in ESKD patients who were admitted to the hospital requiring IHD and ultrafiltration. Inferior vena cava maximum diameter (IVCd), portal vein Doppler (PVD), and hepatic vein Doppler (HVD) were performed in all patients before and after a single IHD session.
Forty-one patients were included. The prevalence of venous congestion was 88% based on IVCd and 63% based on portal vein pulsatility fraction (PVPF). Both mean IVCd and PVPF displayed a significant improvement after ultrafiltration. The percent decrease in PVPF was significantly larger than the percent decrease in IVCd. HVD alterations did not significantly improve after ultrafiltration.
Our study revealed a high prevalence of venous congestion in hospitalized ESKD patients undergoing hemodialysis. After a single IHD session, there was a significant improvement in both IVCd and PVPF. HVD showed no significant improvement with one IHD session. PVPF changes were more sensitive than IVCd changes during volume removal. This study suggests that, due to its rapid response to volume removal, PVD, among the various components of the VExUS grading system, could be more effective in monitoring real-time decongestion in patients undergoing IHD.
确定接受间歇性血液透析（IHD）患者的超滤量是评估和管理容量状态的重要组成部分。静脉过度超声（VExUS）是一种用于在床边量化静脉淤血严重程度的新型工具。鉴于终末期肾病（ESKD）患者中肺动脉高压的高患病率，静脉多普勒可能是监测这些患者淤血消退的有用工具。
这是一项对因需要IHD和超滤而入院的ESKD患者进行的前瞻性观察性研究。在单次IHD治疗前后，对所有患者进行下腔静脉最大直径（IVCd）、门静脉多普勒（PVD）和肝静脉多普勒（HVD）检查。
纳入41例患者。基于IVCd的静脉淤血患病率为88%，基于门静脉搏动分数（PVPF）的患病率为63%。超滤后平均IVCd和PVPF均有显著改善。PVPF的下降百分比显著大于IVCd的下降百分比。超滤后HVD改变无显著改善。
我们的研究显示，住院接受血液透析的ESKD患者中静脉淤血患病率很高。单次IHD治疗后，IVCd和PVPF均有显著改善。单次IHD治疗后HVD无显著改善。在容量清除过程中，PVPF变化比IVCd变化更敏感。本研究表明，由于其对容量清除的快速反应，在VExUS分级系统的各个组成部分中，PVD在监测IHD患者实时淤血消退方面可能更有效。
