Abbreviated Point-of-Care-Ultrasound Volume Assessment for Outpatient Hemodialysis Patients.

OBJECTIVE

To evaluate the safety and feasibility of an abbreviated lung and inferior vena cava (IVC) point-of-care ultrasound (POCUS) protocol for outpatient hemodialysis volume assessment when compared with standard practice.

PATIENTS AND

METHODS

In this prospective case-control study, adults receiving long-term in-center hemodialysis underwent abbreviated POCUS-assisted assessment (n=15, 34%) or standard clinical assessment (non-POCUS, n=29, 66%). POCUS was performed during dialysis using a 6-zone lung ultrasound protocol with IVC assessment. Hypervolemia was defined as ≥3 B lines in ≥2 lung zones with bilateral involvement or an IVC diameter ≥2.1 cm with <50% collapsibility. The primary outcome was change in estimated dry weight (EDW) guided by POCUS when compared with standard clinical assessment. Secondary outcomes included falls, all-cause and hypervolemia-related hospitalizations, antihypertensive medication changes, and mortality.

RESULTS

All POCUS participants (15/15, 100%) met hypervolemia criteria at the initial assessment and underwent EDW reduction; 46.7% met criteria at repeat assessment. Median POCUS examination time was 6 minutes (range 4-10). Reductions in prescribed EDW occurred more frequently in the POCUS group (100% vs 41.4%). Postdialysis weight remained higher relative to new prescribed EDW in the POCUS group at study end. No significant differences were observed in intradialytic blood pressure (P=.24), falls (P=.98), or hospitalizations (P=.67), and no hypervolemia-related hospitalizations (P=.54) occurred in the POCUS group.

CONCLUSION

An abbreviated 6-zone lung and IVC POCUS protocol is feasible and safe in outpatient hemodialysis and prompts earlier EDW adjustment. Larger randomized studies are needed to determine its impact on sustained volume control and clinical outcomes.