Potential implications of subclinical hypervolemia, identified by a multiparametric approach, in causing left ventricular hypertrophy in clinically euvolemic children on dialysis: a prospective longitudinal pilot study

Q: What are the key findings of this study?

Subclinical hypervolemia in clinically euvolemic children on dialysis was associated with a significantly higher occurrence of left ventricular hypertrophy at final follow-up compared to euvolemia (75% vs. 27%, p=0.04).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Chronic dialysis (n=23). Intervention: Subclinical hypervolemia vs. Euvolemia. Primary outcome: Left ventricular hypertrophy (LVH) at final follow-up (p=0.04).

Q: What does this research mean for the field?

Subclinical hypervolemia in clinically euvolemic children on dialysis is associated with a 75% occurrence of left ventricular hypertrophy compared to 27% without it. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Marco Allinovi; Valentina Querin; Silvia Menale; Andrea La Tessa; Alice Brambilla; Ilaria Farella; Luigi Cirillo; Gianmarco Lugli; Carmela Errichiello; Giulio Porcedda; Francesca Miselli; Martina Giacalone; Francesca Becherucci

doi:10.1007/s00467-026-07159-z

January 30, 2026Pediatric NephrologyOpen Access

Potential implications of subclinical hypervolemia, identified by a multiparametric approach, in causing left ventricular hypertrophy in clinically euvolemic children on dialysis: a prospective longitudinal pilot study

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Key result

Subclinical hypervolemia in clinically euvolemic pediatric dialysis patients is linked to a ~178% higher LVH rate.

P=0.04
n=23

Figures

Why the study?

Studies investigating the cardiovascular effects of persistent subclinical hypervolemia in children undergoing dialysis are lacking.

Does subclinical hypervolemia identified by a multiparametric approach correlate with left ventricular hypertrophy in clinically euvolemic children on dialysis?

Key Points

To assess the combined use of lung ultrasound, bioimpedance spectroscopy, and inferior vena cava collapsibility index to detect subclinical hypervolemia and examine its relationship with left ventricular hypertrophy in clinically euvolemic children receiving chronic dialysis.
Conducted a prospective, longitudinal, monocentric observational pilot study in Italy enrolling 23 children under 18 years of age on chronic hemodialysis or peritoneal dialysis with at least 12 months of follow-up.
Evaluated fluid status every 2 months via physical examination, lung ultrasound (LUS), inferior vena cava collapsibility index (IVC-CI), and bioimpedance spectroscopy (BIS), paired with echocardiography every 6 months.
Interdialytic weight gain in clinically euvolemic patients correlated positively with LUS B-lines (R = 0.2923, p < 0.001) and BIS OH/ECW (R = 0.4144, p < 0.001), and negatively with IVC-CI (R = -0.2597, p = 0.019).
Left ventricular mass index demonstrated a significant linear correlation with average pre-dialysis systolic blood pressure over the preceding 6 months (R2 = 0.16, p = 0.002).
Children with subclinical hypervolemia had significantly higher rates of hospitalization for hypertensive crises (67% vs. 0%, p < 0.01) and left ventricular hypertrophy at final follow-up (75% vs. 27%, p = 0.04).

Study Design

Type

Observational (n=23)

Multicenter

No

Structured PICO

Does subclinical hypervolemia identified by a multiparametric approach correlate with left ventricular hypertrophy in clinically euvolemic children on dialysis?

P

Population

23 clinically euvolemic children on chronic dialysis, aged under 18 years, followed for at least 12 months to assess the cardiac impact of subclinical hypervolemia.

E

Exposure

Multiparametric fluid status evaluation using lung ultrasound (LUS), bioimpedance spectroscopy (BIS), and inferior vena cava collapsibility index (IVC-CI) every 2 months to identify subclinical hypervolemia.

C

Comparator

Euvolemic children identified by the same multiparametric approach.

O

Outcome

Occurrence of left ventricular hypertrophy (LVH) at final follow-up and hospitalizations due to hypertensive crises.surrogate

Main Result

Absolute Event Rate: 75% vs 27%

p-value: p=0.04

In clinically euvolemic children on dialysis, a multiparametric approach using LUS, BIS, and IVC-CI can identify subclinical hypervolemia, which is significantly associated with left ventricular hypertrophy and hypertensive crises.

Limitations

Monocentric pilot study with a small sample size
Inclusion of two different dialysis modalities (hemodialysis and peritoneal dialysis) introducing potential heterogeneity
LVH is influenced by additional factors other than hypervolemia that could have been overlooked
Multiparametric evaluation in peritoneal dialysis patients was not performed at the peak of interdialytic hypervolemia
Time of enrollment did not coincide with the start of dialysis or achievement of stable dry weight
Speckle tracking analysis by echocardiography was not performed
Lack of detailed information on antihypertensive medication use and standardized 24-h ABPM measurements
LUS and IVC-CI are operator-dependent techniques
Blood volume monitoring and serum NT-proBNP levels were not tested
Small sample size
Monocentric design
Lack of multivariable regression analyses due to risk of overfitting

Implication

Subclinical hypervolemia was associated with more LVH in euvolemic pediatric dialysis patients; hypothesis-generating and should not yet change practice.

Abstract

Background Fluid overload in children undergoing dialysis can lead to serious cardiac complications, i.e., left ventricular hypertrophy (LVH) and cardiac dysfunction. Studies investigating the cardiovascular effects of persistent subclinical hypervolemia—characterized by euvolemia at clinical assessment but hypervolemia at technical evaluation—are lacking. This pilot study explored the combined use of lung ultrasound (LUS), bioimpedance spectroscopy (BIS), and ultrasound assessment of the inferior vena cava collapsibility index (IVC-CI) to identify subclinical hypervolemia and investigated its cardiac impact. Methods In this longitudinal study, we recruited 23 children on chronic dialysis who underwent fluid status evaluation (physical examination, LUS, IVC-CI, BIS) every 2 months and echocardiography every 6 months. Results In clinically euvolemic patients, we observed a significant positive correlation between the interdialytic weight gain and the number of B-lines observed by LUS ( R = 0.2923, p < 0.001); similar results were obtained for the OH/ECW measured by BIS ( R = 0.4144, p < 0.001), while a negative correlation with IVC-CI ( R = − 0.2597, p = 0.019) was observed. Moreover, we identified a significant linear correlation between left ventricular mass index values and the average pre-dialysis systolic blood pressure measured over the preceding 6 months ( R 2 = 0.16, p = 0.002). Hospitalizations due to hypertensive crises (67% vs. 0%, p < 0.01) and the occurrence of LVH at the final follow-up (75% vs. 27%, p = 0.04) were notably more frequent in children with subclinical hypervolemia. Conclusion In clinically euvolemic children on dialysis, the combined use of LUS, BIS, and IVC-CI (multiparametric approach) effectively quantified subclinical hypervolemia, which was correlated with the risk of LVH.

Discussion

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Cite This Study

Allinovi et al. (2026) conducted an observational in Chronic dialysis (n=23). Subclinical hypervolemia vs. Euvolemia was evaluated on Left ventricular hypertrophy (LVH) at final follow-up (p=0.04). Subclinical hypervolemia in clinically euvolemic children on dialysis was associated with a significantly higher occurrence of left ventricular hypertrophy at final follow-up compared to euvolemia (75% vs. 27%, p=0.04).

synapsesocial.com/papers/6980feabc1c9540dea810f0d https://doi.org/10.1007/s00467-026-07159-z

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Potential implications of subclinical hypervolemia, identified by a multiparametric approach, in causing left ventricular hypertrophy in clinically euvolemic children on dialysis: a prospective longitudinal pilot study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Potential implications of subclinical hypervolemia, identified by a multiparametric approach, in causing left ventricular hypertrophy in clinically euvolemic children on dialysis: a prospective longitudinal pilot study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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