Abstract: TH-PO194
Seeing the Volume for the Bs: Longitudinal Variation in Ultrasound-Guided Volume Assessment in Hemodialysis Patients
Session Information
- Hemodialysis and Frequent Dialysis - I
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid and Electrolytes
- 902 Fluid and Electrolytes: Clinical
Authors
- Kumar, Anubhav, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Cassella, Courtney R., University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Bonnel, Alexander, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Matthias, Isaac, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Moore, Christy, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Panebianco, Nova, University of Pennsylvania, Philadelphia, Pennsylvania, United States
Background
Ultrasound (US) studies in hemodialysis (HD) patients have demonstrated improvements in lung water from the beginning to the completion of HD. These studies, however, have focused primarily on the pre-, intra-, and immediate post-dialytic periods. There are no published studies examining how fluid shifts between the intravascular and interstitial compartments in the post-dialysis period. This study aimed to characterize this phenomenon.
Methods
In this single-center, prospective observational study, patients with acute kidney injury and end-stage renal disease receiving HD in an inpatient HD unit at an urban academic medical center were recruited to receive three US volume assessments: first within two hours before HD, second within an hour following HD conclusion, and third four hours after HD conclusion. US volume assessment consisted of assessment of inferior vena cava (IVC) variability and 28-point lung ultrasound (LUS) with B-line scoring per zone (BLZ).
Results
In a preliminary analysis, IVC variability increased a mean of 21.1% in three of the four subjects (range 29.9 to 23.2%) between the pre-HD and post-HD period. At the extended post-HD period, the same three subjects demonstrated a mean decrease in IVC variability of 19.1% (range 10.9 to 23.2%), whereas a fourth subject experienced an increase in IVC variability of 19.9%. The BLZ results were mixed, without clear signal across the four patients.
Conclusion
In preliminary analysis, IVC variability appeared to decrease in the extended post-HD period compared to the immediate post-HD period. BLZ did not show a signal for increase or decrease in the same period. The study is continuing to recruit patients for further analysis.