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Abstract: SA-OR073

Using IVC Collapsibility and Lung Ultrasound to Determine Ultrafiltration Goal in Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kattamanchi, Siddhartha, Icahn School of Medicine at Mount Sinai , New York, New York, United States
  • Bapat, Manasi, Icahn School of Medicine, Mount Sinai Hospital, NY, New York, New York, United States
  • Nadkarni, Girish N., Ichan School of Medicine, New York, New York, United States
  • Tokita, Joji E., Mount Sinai School of Medicine, New York, New York, United States
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai , New York, New York, United States
Background

Intra-dialytic hypotension (IDH) and pulmonary congestion are two problems at the opposite ends of the spectrum of the problems related to volume status management in ESRD patients. Current clinical assessment tools to predetermine ultrafiltration (UF) goal in hospitalized patients are inadequate. We sought to determine the utility of employment of hand-held ultrasound at the bedside to adjust goal UF in hospitalized HD patients.

Methods

Hospitalized patients receiving HD for AKI or ESRD in the MSH inpatient dialysis unit were eligible for participation in this pilot study at Mount Sinai Hospital. HD encounters were randomized to the ultrasound-assisted UF goal (intervention group) vs. standard of care to determine UF goal (control arm). In the intervention group, the UF rate ordered by the treating nephrologists was additionally adjusted based upon IVC collapsibility and lung ultrasound patterns assessed immediately prior to the start of HD, as shown in the Table. The primary outcomes were A. Intradialytic hypotension (IDH) and B. Moderate to severe congestion on the end of HD.

Results

There were 26 HD encounters in the intervention arm and 26 in the control arm. Based on the US findings, the UF goal was changed in 12 out of 26 (46%) HD patients in the intervention group; Among those 12, 6 patients were classified as hypervolemic and had their UF goal increased, and 6 patients were classified as hypovolemic and had their UF goal decreased. IDH was observed in 1 patient in the intervention arm vs. 4 patients in the control arm. Post-dialysis pulmonary congestion was seen in 2 patients in the intervention arm vs. 4 patients in control group.

Conclusion

This pilot study suggests that adjusting UF goal based on US findings may improve precision of the optimal UF for that HD session and has the potential to decrease incidence of IDH and post-dialysis pulmonary congestion.

Intervention Arm Protocol for UF Adjustment
CVP based on IVCLung USINTERPRETATIONUF adjustment
>10B line patternHypervolemic1L more than last time
6-10A line patternEuvolemicUF not adjusted
<6A line patternHypovolemic<1L