Gudiño-Bravo Pedro, Posada-Martinez Edith L, Cano-Nieto Mariana M, Ibarra-Marquez Nikein D, Leal-Escobar Gabriela, Madero Magdalena, Rodriguez-Iturbe Bernardo, Ivey-Miranda Juan B, Lopez-Gil Salvador
Nephrology Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico,
Laboratory of Echocardiography, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
Blood Purif. 2025;54(1):62-70. doi: 10.1159/000542012. Epub 2024 Nov 4.
Fluid overload is a frequent and serious complication in hemodialysis patients. The combination of multiple point-of-care ultrasound (POCUS) measurements can identify significant venous congestion, but its usefulness to determine ultrafiltration (UF) requirements and dry weight is unknown. Therefore, we evaluated prospectively patients in maintenance hemodialysis to establish the correlations between changes in venous congestion parameters and fluid removal.
This was a prospective, single-center, observational study. POCUS venous congestion measurements were performed in 22 patients during 32 online post-dilutional hemodiafiltration sessions, and findings were correlated with UF volume, central venous pressure, and body water composition determined by multifrequency bioelectric impedance analysis (BIA).
The pre-dialysis weight was on average 1.9 kg above the BIA estimated dry weight, the average initial inferior vena cava (IVC) diameter was <2 cm. An initial abnormal hepatic vein (HV) waveform was present in 26% (8) of the measurements. The average UF volume was 2,084 ± 655 mL and correlated with changes in IVC diameter (R = 0.34, 95% CI: [0.18, 0.56], p < 0.05) but not with any other POCUS venous congestion parameters. Normalization of the IVC diameter and HV waveform was observed during the first UF hour in all initially altered measurements. Diameter reduction in the IVC correlated with total body water volume reduction estimated with BIA when measured immediately after fluid removal (R = 0.34, 95% CI: [0.08, 0.56], p < 0.05).
Reduction in IVC diameter had a modest but significant correlation with UF volume in our patients on maintenance hemodiafiltration. POCUS may be used to monitor patients during UF.
液体过载是血液透析患者常见且严重的并发症。多种床旁超声（POCUS）测量相结合可识别明显的静脉淤血，但其对确定超滤（UF）需求和干体重的作用尚不清楚。因此，我们对维持性血液透析患者进行了前瞻性评估，以建立静脉淤血参数变化与液体清除之间的相关性。
这是一项前瞻性、单中心观察性研究。在22例患者的32次在线后稀释血液透析滤过治疗过程中进行了POCUS静脉淤血测量，并将结果与超滤量、中心静脉压以及通过多频生物电阻抗分析（BIA）测定的身体水分组成相关联。
透析前体重平均比BIA估计的干体重高1.9kg，平均初始下腔静脉（IVC）直径<2cm。26%（8次）测量中初始肝静脉（HV）波形异常。平均超滤量为2084±655mL，与IVC直径变化相关（R = 0.34，95%CI：[0.18, 0.56]，p < 0.05），但与任何其他POCUS静脉淤血参数无关。在所有初始改变的测量中，在首次超滤小时内观察到IVC直径和HV波形恢复正常。在液体清除后立即测量时，IVC直径减小与BIA估计的总体液量减少相关（R = 0.34，95%CI：[0.08, 0.56]，p < 0.05）。
在我们的维持性血液透析滤过患者中，IVC直径减小与超滤量有适度但显著的相关性。POCUS可用于在超滤过程中监测患者。
