Key result
POCUS-guided volume assessment prompts ~59-point higher rate of dry weight reductions in hemodialysis.
Why the study?
The safety and feasibility of an abbreviated lung and IVC POCUS protocol for volume assessment in outpatient hemodialysis patients compared with standard practice was not established.
Does an abbreviated 6-zone lung and IVC point-of-care ultrasound (POCUS) volume assessment protocol increase adjustments in estimated dry weight (EDW) safely compared with standard clinical assessment in adults on long-term outpatient hemodialysis?
Case-Control (n=44)
Open-label (intervention assignment was not blinded)
Subset of 15 patients randomly selected from hemodialysis shifts after patient and provider consent and availability
No
Does an abbreviated 6-zone lung and IVC point-of-care ultrasound (POCUS) volume assessment protocol increase adjustments in estimated dry weight (EDW) safely compared with standard clinical assessment in adults on long-term outpatient hemodialysis?
An abbreviated 6-minute, 6-zone lung and IVC point-of-care ultrasound protocol during outpatient hemodialysis is safe and feasible, detecting subclinical pulmonary congestion and prompting more frequent dry weight reductions than physical examination alone.
Answers are grounded in this paper and cite their sources.
May prompt more EDW reductions than standard assessment in hemodialysis; leaves open outcome benefits in randomized trials.
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.
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Ritchie et al. (2026) conducted a case-control in End-stage kidney disease (ESKD) on long-term in-center hemodialysis (n=44). Abbreviated 6-zone lung and inferior vena cava (IVC) point-of-care ultrasound (POCUS) volume assessment protocol vs. Standard clinical practice volume assessment (vital signs, weight trends, laboratory data, history and physical examination) was evaluated on Change in prescribed estimated dry weight (EDW) target (Challenge EDW) (p=<0.001). Abbreviated POCUS volume assessment prompted prescribed estimated dry weight reductions in 100% of hemodialysis patients compared with 41.4% under standard clinical assessment.
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