Ultrasonographic Evaluation of Systemic Venous Congestion in Maintenance Hemodialysis Patients During Fluid Removal.

IF 2.2 3区 医学 Q3 HEMATOLOGY Blood Purification Pub Date : 2024-11-04 DOI:10.1159/000542012
Pedro Gudiño-Bravo, Edith L Posada-Martinez, Mariana M Cano-Nieto, Nikein D Ibarra-Marquez, Gabriela Leal-Escobar, Magdalena Madero, Bernardo Rodriguez-Iturbe, Juan B Ivey-Miranda, Salvador Lopez-Gil
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Abstract

Introduction: 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.

Methods: This was a prospective, single-center, observational study. POCUS venous congestion measurments 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).

Results: The pre dialysis weight was on average 1.9 kg above the BIA estimated dry weight, the average initial 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 2084 ± 655 ml and correlated with changes in inferior vena cava (IVC) diameter (R= 0.34, CI 95% (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, CI 95% (0.08, 0.56) p<0.05) Conclusion. 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.

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超声波评估维持性血液透析患者在液体清除过程中的全身静脉充血情况。
简介液体超负荷是血液透析患者经常出现的一种严重并发症。结合多种护理点超声波(POCUS)测量可识别严重的静脉充血,但其在确定超滤(UF)需求和干重方面的作用尚不清楚。因此,我们对维持性血液透析患者进行了前瞻性评估,以确定静脉充血参数变化与液体排出量之间的相关性:这是一项前瞻性、单中心观察研究。在 32 次在线稀释后血液透析过程中,对 22 名患者进行了 POCUS 静脉充血测量,并将测量结果与 UF 容量、中心静脉压和通过多频生物电阻抗分析(BIA)确定的体内水分成分相关联:结果:透析前的体重比 BIA 估算的干重平均高出 1.9 千克,初始 IVC 平均直径为 0.5 毫米,透析后的 IVC 平均直径为 0.5 毫米。
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来源期刊
Blood Purification
Blood Purification 医学-泌尿学与肾脏学
CiteScore
5.80
自引率
3.30%
发文量
69
审稿时长
6-12 weeks
期刊介绍: Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.
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