Kidney Week

Abstract: FR-PO0579

Femoral Vein Pulsatility by Doppler Ultrasonography as a Marker of Pulmonary Hypertension in Hemodialysis

Session Information

• CKM: Clinical - Meta-Analyses, Predictive Modeling, Care Delivery, and Safety
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Núñez Morales, Alfonso Gabriel, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

Alfonso Gabriel Núñez Morales, MD

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

Eduardo R. Argaiz, MD, PhD

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

Konighinn Ludwika Derflingher Hernández, MD

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

Adolfo Diaz Cabral, MD

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

Jacqueline M. Sanchez-Dominguez, MD

• Said, J. Emilio, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico

J. Emilio Said, MD

• Carrillo, Natalia Michel, Universidad Nacional Autonoma de Mexico, Mexico City, CDMX, Mexico

Natalia Michel Carrillo, PA

Background

Hemodialysis patients have a high prevalence of pulmonary hypertension (PH), a prognostic factor closely associated with volume overload. Early detection allows dry weight adjustments to prevent cardiovascular events; however, it currently relies on advanced echocardiography. This study evaluated femoral vein flow pulsatility, measured by Doppler ultrasound, as an accessible diagnostic marker for PH and its response to ultrafiltration

Methods

An observational study evaluated 112 patients during their short interdialytic period. Femoral vein pulsatility and inferior vena cava (IVC) diameter were measured, alongside a transthoracic echocardiogram. Pulmonary hypertension (PH) was defined as a tricuspid regurgitation velocity (TRVmax) > 2.8 m/s. Logistic regression analysis was performed to assess association with PH. In a subgroup of 24 patients, hemodynamics were documented before and after ultrafiltration.

Results

PH was identified in 31% of the cohort. Femoral vein pulsatility was markedly higher in patients with PH compared to those without (90.7 ± 46.1 vs 28.1 ± 30.4, p < 0.001), demonstrating a strong discriminatory signal. Diagnostic performance analysis revealed that femoral pulsatility achieved an area under the receiver operating characteristic curve (AUC) of 0.88. This performance was numerically superior to IVC diameter (AUC 0.81), suggesting incremental value over conventional parameters of congestion. In a predefined subgroup undergoing ultrafiltration (n=24; mean volume 2.4 ± 0.8 L), femoral pulsatility significantly decreased following the hemodialysis session (p = 0.002), supporting its sensitivity to dynamic intravascular volume changes and reinforcing its physiological relevance.

Conclusion

Doppler-derived femoral vein pulsatility demonstrates strong discriminatory capacity for detecting pulmonary hypertension in hemodialysis patients and may outperform conventional IVC-based assessment. Beyond its diagnostic performance, it reflects hemodynamic changes following ultrafiltration. These findings support its potential role as a practical bedside tool for volume status assessment and dry weight optimization, warranting validation in larger studies.