Sakai Masafumi, Yoshida Keisuke, Shirai Kana, Kitano Fumiya, Shibagaki Yugo, Yazawa Masahiko
Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
Department of Internal Medicine, Yokohama General Hospital, Yokohama, Japan.
Nephrology (Carlton). 2025 Jun;30(6):e70060. doi: 10.1111/nep.70060.
Point-of-care ultrasound (POCUS) is an essential bedside tool in nephrology for evaluation of fluid volume, acute kidney injury (AKI), and vascular access. In Japan, nephrology-oriented POCUS education remains underdeveloped, despite its clinical significance. This study aimed to evaluate the effects of a POCUS educational programme on POCUS implementation in clinical nephrology.
This single-centre observational study was conducted between 2022 and 2024 and comprised 162 patients with AKI. We compared POCUS use, including the checking of the inferior vena cava diameter, urinary obstruction, and venous excess ultrasound (VExUS) grading system, before and after lectures and hands-on training in 2023.
There was a significant increase in POCUS implementation for AKI evaluation, including VExUS for assessing congestion. Post-training, the procedure implementation of VExUS for patients with congestion (N = 29) increased from 0% in 2022 to 66.7% in 2023 and 56.3% in 2024. Severe congestion by VExUS might be related to poor outcomes, including higher rates of haemodialysis and mortality. Despite technical difficulties in visualising renal interlobular veins using pulse-wave Doppler in VExUS, the visualisation rate improved over time, increasing from 50% in 2023 to 66.7% in 2024.
These results underscore the importance of developing comprehensive nephrology-oriented POCUS training programmes, even at the facility level, coupled with on-the-job training to improve clinical use. However, the procedure implementation of VExUS plateaued in years when the lectures were not conducted. Thus, regularly conducted lectures, the development of supervising physicians' teaching skills, and the implementation of a robust training system would be necessary.
即时超声检查（POCUS）是肾脏病学中用于评估血容量、急性肾损伤（AKI）和血管通路的重要床边工具。在日本，尽管具有临床意义，但以肾脏病学为导向的POCUS教育仍不发达。本研究旨在评估POCUS教育计划对临床肾脏病学中POCUS实施的影响。
本单中心观察性研究于2022年至2024年进行，纳入162例AKI患者。我们比较了2023年讲座和实践培训前后POCUS的使用情况，包括下腔静脉直径检查、尿路梗阻检查和静脉过度超声（VExUS）分级系统。
用于AKI评估的POCUS实施有显著增加，包括用于评估充血的VExUS。培训后，充血患者（N = 29）的VExUS程序实施率从2022年的0%增加到2023年的66.7%和2024年的56.3%。VExUS显示的严重充血可能与不良结局有关，包括更高的血液透析率和死亡率。尽管在VExUS中使用脉冲波多普勒观察肾小叶间静脉存在技术困难，但随着时间的推移，观察率有所提高，从2023年的50%增加到2024年的66.7%。
这些结果强调了制定全面的以肾脏病学为导向的POCUS培训计划的重要性，即使在机构层面，同时进行在职培训以改善临床应用。然而，在未举办讲座的年份，VExUS的程序实施趋于平稳。因此，定期举办讲座、培养指导医师的教学技能以及实施完善的培训系统是必要的。
