Kidney Week

Abstract: PUB103

Point-of-Care Ultrasonography (POCUS)-Driven Strategy to Improve Hypertension in Hemodialysis: A Quality Improvement Project

Session Information

• Publication Only

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Shah, Samveg, University of Toronto, Toronto, Ontario, Canada

Samveg Shah, MD

• Shah, Meera, University of Toronto, Toronto, Ontario, Canada

Meera Shah, MD

• Asif, Sabaa, University of Toronto, Toronto, Ontario, Canada

Sabaa Asif, MBBS, FASN

• Alzahrani, Mohammed, University of Toronto, Toronto, Ontario, Canada

Mohammed Alzahrani, MBBS

• Pasricha, Sachin V., University of Toronto, Toronto, Ontario, Canada

Sachin V. Pasricha, MD

• Tanna, Gemini, University of Toronto, Toronto, Ontario, Canada

Gemini Tanna, MD

• Auguste, Bourne L., University of Toronto, Toronto, Ontario, Canada

Bourne L. Auguste, MD, MSc

• Zahirieh, Alireza, University of Toronto, Toronto, Ontario, Canada

Alireza Zahirieh, MD

Background

Hypertension is a common cardiovascular risk factor in hemodialysis (HD) patients, often due to volume overload. Traditional clinical assessments of volume status are limited. Point-of-care ultrasound (PoCUS), including lung, IVC, and Venous Excess Ultrasound (VeXUS) offer more objective and reproducible evaluation. Incorporating PoCUS may enable precise dry weight management and improve blood pressure (BP) control.

Methods

Reduce the proportion of patients with uncontrolled hypertension by 60% on a single dialysis shift—without increasing adverse events—using a PoCUS-guided volume management strategy at a teaching hospital in Toronto, Canada.

A pre-intervention chart review in January 2025 found that 22% of patients on an evening shift had uncontrolled hypertension (SBP >140 mmHg on ≥2 antihypertensives). The intervention included biweekly comprehensive PoCUS scans by a trained physician, with formal documentation and dry weight recommendations for dialysis staff. The primary outcome was change in mid-week intradialytic BP. Process measures included scan counts and uptake of PoCUS recommendations. Balancing measures tracked intradialytic hypotension, cramping, added ultrafiltration sessions, and hospitalizations for volume-related complications.

Results

Five patients (mean age 54.2 years, 80% male) were monitored over two scanning cycles (January and April 2025), with 16 PoCUS scans completed (Fig 1). BP improved in 60% of patients following the intervention. PoCUS findings differed from clinical volume assessments in 31% of cases; 60% of these led to changes in management. Two patients reported cramping—one found to be volume depleted on PoCUS. No intradialytic hypotension, hospitalizations, or additional ultrafiltration sessions occurred.

Conclusion

Routine PoCUS-guided assessments may improve BP control in HD patients by informing volume management. This pilot highlights its potential as a clinical exam adjunct, warranting further study to assess long-term benefits.

Median mid-week SBP (mm Hg) of 5 HD patients with uncontrolled hypertension on days of PoCUS assessments.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025tcbjxv5d