Kidney Week

Abstract: FR-PO0124

Venous Congestion Detected by Abnormal Internal Jugular Vein Ultrasonography Predicts Lack of Response to Initial Treatment for AKI in Cirrhosis

Session Information

• AKI: Epidemiology and Clinical Trials
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Sanchez-Dominguez, Jacqueline M., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico

Jacqueline M. Sanchez-Dominguez, MD

• Prado, Alejandro Esteban, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico

Alejandro Esteban Prado, MD

• Diaz Cabral, Adolfo, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico

Adolfo Diaz Cabral, MD

• Derflingher Hernández, Konighinn Ludwika, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico

Konighinn Ludwika Derflingher Hernández, MD

• Argaiz, Eduardo R., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico

Eduardo R. Argaiz, MD, PhD

Background

Acute kidney injury (AKI) in Cirrhosis can be caused by hypovolemia, hepatorenal syndrome or venous congestion (hepatocardiorenal syndrome). Distinguishing between these is important because conventional treatment involves administration of intravenous volume, which can be detrimental to congestive patients.

Methods

A unicentric, longitudinal, prospective study was conducted in a tertiary care center to determine the utility of internal jugular vein (IJV) ultrasound in the first 12 hours from patient’s emergency department arrival, as a screening tool for venous congestion and its impact on probability of improvement of the AKI at 48 hours and 14 days, in patients with cirrhosis and AKI of all types except for obstructive and glomerulonephritis. Exclusion criteria was chronic kidney disease KDIGO 5 and/or on mechanical ventilation.

Results

75 patients were included in a 10-month period, most classified as Child Pugh C (50.7%) with a median MELD-Na score of 19 points and median age of 62 years. Main cause of admission was infection (52%). At presentation, AKI KDIGO 1 and 2 was 44 and 39%, respectively. IJV ultrasound was abnormal/congestive (collapsibility index <24.8% at level 1 of the neck) in 21.3% patients, with altered cardiac function confirmed by echocardiography. Treatment for AKI in the first 48 hours consisted mainly of volume expansion (89%) with just 31 and 48% receiving vasopressors or diuretics. Only 19% of patients with venous congestion had an improvement at 48-hour SCr (defined as a decrease >0.3 mg/dl), compared with 60% in those with a normal IJV (p<0.005). An abnormal IJV had an OR 6.23 (CI 1.81 – 29.76, p = 0.007) for no improvement or death at 48 hours and an OR 4.90 (CI 1.49 – 16.63, p = 0.009) for no improvement at 14 days. Renal replacement therapy was required in 3 (18%) congestive patients compared to 0 of non-congestive patients.

Conclusion

21% of patients showed signs of venous congestion detected by IJV. These patients are unlikely to respond to initial treatment in the first 48 hours (mostly volume expansion) and have worse kidney outcomes at 14 days. IJV ultrasound could be implemented in the evaluation of patients with AKI and cirrhosis due to potential changes in treatment.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025yqsqp8sa