Abstract
Introduction: Volume overload contributes to cardiovascular and all-cause mortality in hemodialysis patients.
Objectives: To assess agreement between point-of-care ultrasonography (POCUS) and standard clinical assessment for evaluating volume status in maintenance hemodialysis patients, using bioimpedance analysis (BIA) as a reference.
Patients and Methods: This cross-sectional study included 45 end-stage renal disease (ESRD) patients on maintenance hemodialysis. Patients with decompensated liver disease, ascites, heart failure, active infection, or pregnancy were excluded. Volume status was assessed before and after mid-week dialysis using blinded clinical evaluation and POCUS, including lung ultrasound (B-lines), inferior vena cava (IVC) diameter, IVC collapsibility index, and focused echocardiography (FOCUS). Furthermore, POCUS was conducted by a blinded operator, since BIA served as the reference standard.
Results: In linear regression analyses, post-dialysis reductions in right ventricular (RV) longitudinal dimension, left ventricular end-diastolic dimension (LVEDD), and B-lines predicted BIA-estimated excess weight in the POCUS model (all P<0.05), whereas post-dialysis reductions in RV longitudinal dimension, left ventricular end-systolic dimension (LVESD) and the clinical estimated weight predicted it in the combined clinical and POCUS model (all P<0.05). The combined use of clinical assessment and POCUS demonstrated the strongest agreement with BIA (ICC = 0.826, P<0.001) and the highest accuracy, with 64.4% of the patients showing weight difference of ≤0.5 kg compared with BIA estimates.
Conclusion: Integrating clinical assessment with POCUS improves the accuracy and reliability of volume status evaluation in hemodialysis patients compared with either method alone. Our limitations in this study were the single-center design, small sample size, and operator dependence of POCUS measurements.