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Abstract: PO0882

Evaluation of Venous Congestion in Chronic Hemodiafiltration Patients During Ultrafiltration: A Prospective Cohort Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Gudiño Bravo, Pedro, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
  • Cano Nieto, Mariana Montserrat, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
  • Ibarra Marquez, Nikein Dayan, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
  • Leal, Gabriela, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
  • Madero, Magdalena, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
  • Posada-Martinez, Edith Liliana, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
  • Gil, Salvador Lopez, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
Background

Fluid overload is deleterious in chronic hemodialysis patients. The combination of multiple POCUS markers can identify significant venous congestion. These markers have not been prospectively studied in this population.

Methods

We measured inferior vena cava (IVC) diameter, portal vein pulsatility fraction (PVPF), jugular vein at rest (YVR) and hepatic vein flow (HVF) at five points: pre-dialysis, three times during dialysis and post-dialysis. All measurements were done three times and averaged. All patients had at least 3% weight gain based on their estimated dry weight. We recorded ultrafiltration volume at each point.

Results

We performed measurements during 30 on-line post dilution hemodiafiltration sessions in 20 patients (13 were female, mean age 38.6 years old). The average total ultrafiltration (UF) volume was 2501.5 cc (1250-4250 cc). There was a significant reduction in PVPF, IVC diameter, YVR, HVF during sessions. See Figure 1. Likewise, UF volume correlated with IVC diameter: R -0.38 p<0.001; PVPF: R -0.31 p<0.001; and HVF: R -0.19 p=0.035.

Conclusion

In chronic hemodialysis patients, even in the absence of a dilated IVC, markers of venous congestion tracked ultrafiltration volume. This study warrants further research with regards to clinical decision to continue fluid removal in chronic hemodialysis patients.

Figure 1. Different POCUS venous congestion markers measured pre-dialysis, intradialysis and post dialysis.