Abstract: FR-PO0403
Diagnostic Reclassification of Volume Status Using Point-of-Care Ultrasonography and Venous Excess Ultrasound in Hospitalized Patients with AKI
Session Information
- AKI: Biomarkers, Diagnostics, and Risk Prediction
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Khan, Sabiha M., VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
- Milligan, Bryce, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
- Rahall, Kristen, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
- Schott, Christopher, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
Background
Point-of-care ultrasound (POCUS) and Venous Excess Ultrasound (VExUS) have emerged as useful noninvasive tools for evaluating AKI at the bedside. Elevated VExUS scores are associated with AKI in critically ill patients, and VExUS-guided diuresis in acute heart failure has been shown to reduce AKI risk. In this prospective pilot study, we assessed venous congestion by POCUS/VExUS in patients with new AKI and investigated whether these findings led to reclassification of volume status compared to clinical impression.
Methods
This study was approved by the VA Pittsburgh IRB, and written consent was obtained from all participants. We enrolled 9 patients with AKI as defined by KDIGO criteria. We surveyed primary teams to determine their clinical impression of volume status and recorded physical examination findings and baseline characteristics. We performed a standardized ultrasound protocol incorporating POCUS and VExUS views. Images were interpreted by two readers, and inter-reader agreement was assessed. We compared clinical impression of volume status to VExUS score.
Results
4/9 patients (44%) were classified as hypovolemic by clinical impression; however, only 2/4 (50%) had VExUS score 0, while the other 2/4 (50%) had elevated scores suggesting occult congestion. None of these patients had physical exam findings of congestion.
5/9 (56%) patients were classified as euvolemic; 3/5 (60%) had elevated VExUS scores and 4/5 had physical exam findings of congestion that did not change clinical classification. Overall, 5/9 (56%) patients had venous congestion not identified clinically.
2/2 patients with VExUS score 0 achieved renal recovery, compared to 4/7 with elevated scores.
Notably, one patient had an isolated abnormal intrarenal venous Doppler waveform (discontinuous monophasic flow) despite otherwise normal VExUS findings. This patient was diagnosed with acute interstitial nephritis and had renal recovery with prednisone, highlighting a novel example of discordant VExUS views from renal pathology unrelated to systemic venous congestion
Conclusion
The POCUS/VExUS protocol identified venous congestion in more than half of AKI patients classified as hypovolemic or euvolemic, suggesting hypervolemia is underestimated by clinical assessment alone and these tools may improve volume assessment. Larger studies are warranted to determine whether VExUS-guided management improves AKI outcomes.