Abstract: SA-PO427
Using Point-of-Care Ultrasonography (POCUS) in Volume Assessment in Patients on Hemodialysis
Session Information
- Hemodialysis and Frequent Dialysis - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Ritchie, Leanna V., Mayo Foundation for Medical Education and Research, Jacksonville, Florida, United States
- Mao, Michael A., Mayo Foundation for Medical Education and Research, Jacksonville, Florida, United States
Background
The POCUS (point-of-care ultrasound) has been well studied in its superior ability to assess high volume status in the heart and lungs, however is not a standard of practice for volume assessment in dialysis patients. Hypervolemia in the end stage kidney disease (ESKD) population is associated with increased mortality and hospitalizations. We hypothesized that POCUS would identify hypervolemia with increased accuracy and safety to reduce hypervolemia complications compared to traditional physical exam.
Methods
This observational cohort study included 62 participants: 15 patients underwent POCUS and 45 patients had volume management by traditional physical exam. Hypervolemia criteria by POCUS included: IVC with < 50% diametric collapsibility, or the detection of at least 3 confluent B lines in >2/6 lung zones with at least one zone positive bilaterally. If exam met criteria for hypervolemia, then estimated dry weight (EDW) was adjusted to a delta of negative 0.5 kg for subsequent dialysis sessions. A traditional clinical physical exam was performed in all patients to assess for hypervolemia. Patients followed for total 6 months including 3 months post intervention for hospitaliztions, heart failure, medication changes, hypotension and death.
Results
In the POCUS group: 100% (15/15) met criteria for hypervolemia on initial POCUS exam and had their EDW adjusted after initial POCUS. However, 7/15 (46.67%) participants demonstrated persistent hypervolemia via second POCUS and underwent a second EDW adjustment. Physical exam identified hypervolemia in 5/15 (33.33%) participants. The average length of POCUS exam decreased from 7.2 minutes to 6.1 minutes on first and second POCUS assessments, respectively. There were no hospitalizations related to hypervolemia in any of the POCUS participants compared to >15% of hospitalization related to complications of hypervolemia in control group.
Conclusion
The POCUS exam is efficient, timely and easy to learn. The use of POCUS is a safe adjunct to clinical volume assessment in the ESKD popoulation to reduce hypervolemia, hospitalization and improve quality of life.