Patel Sharad, Ashokkumar Sandhya, Green Adam
Department of Critical Care Medicine, Cooper University Health Care, 1 Cooper Plaza, Camden, NJ, 08103, USA.
Department of Nephrology, Cooper University Health Care, Camden, NJ, USA.
BMC Nephrol. 2024 Dec 18;25(1):464. doi: 10.1186/s12882-024-03856-9.
Maintaining optimal fluid balance is crucial for patients with end-stage renal disease on dialysis, as both fluid overload and excess removal can lead to poor outcomes. Traditional approaches such as physical exam and chest X-ray have limitations when assessing volume status. This review carefully examines the tools that provide more precise options, including lung ultrasound, echocardiography, Venous Excess Ultrasound (VEXUS), bioimpedance analysis (BIA), and passive leg raise (PLR). We discuss the principles, supporting evidence, and practical uses of these techniques differentiating between static and dynamic methods to evaluate ultrafiltration tolerance. By integrating these modern techniques with clinical judgment, nephrologists can optimize fluid management in dialysis patients. While these tools show promise, further research is needed to establish standardized protocols and evaluate their impact on patient-centered outcomes.
维持最佳的液体平衡对于接受透析的终末期肾病患者至关重要，因为液体过载和过度清除都会导致不良后果。传统的评估方法，如体格检查和胸部X光，在评估容量状态时存在局限性。本综述仔细研究了能提供更精确选择的工具，包括肺部超声、超声心动图、静脉过量超声（VEXUS）、生物电阻抗分析（BIA）和被动抬腿试验（PLR）。我们讨论了这些技术的原理、支持证据以及实际应用，区分了静态和动态方法以评估超滤耐受性。通过将这些现代技术与临床判断相结合，肾病学家可以优化透析患者的液体管理。虽然这些工具显示出了前景，但仍需要进一步研究来建立标准化方案并评估它们对以患者为中心的结局的影响。
