Kidney Week

Abstract: SA-PO1098

Predialysis Venous Excess Ultrasound Grade Correlates with Cardiac and Pulmonary Congestion Rather Than Bioimpedance-Defined Fluid Overload in Patients on Hemodialysis

Session Information

• Kidney Replacement Therapy and Care Delivery Innovations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Banda Lopez, Adriana, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Adriana Banda Lopez, MD

• Cruz Landino, Moises, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Moises Cruz Landino, MD

• Garcia Vallejo, Diana Vianney, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Diana Vianney Garcia Vallejo, MD

• Parra Guerra, Ricardo, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Ricardo Parra Guerra, MD

• Rojas-Campos, Enrique, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Enrique Rojas-Campos, MD

• Mendoza Cabrera, Salvador, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Salvador Mendoza Cabrera, MD

• Piña Vicente, Brandon, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Brandon Piña Vicente, MD

• Ventura Cabrera, Carlos Ernesto, Instituto Mexicano del Seguro Social Delegacion Jalisco, Guadalajara, Jal., Mexico

Carlos Ernesto Ventura Cabrera, MEd

Group or Team Name

• Centro Médico Nacional de Occidente, IMSS

Background

Assessing volume status is critical in patients with End-Stage Kidney Disease (ESKD) on hemodialysis (HD) to achieve dry weight and minimize complications like intradialytic hypotension. While the Venous Excess Ultrasound (VExUS) score is increasingly used, evidence regarding its utility in guiding dynamic fluid removal and its correlation with other congestion markers remains limited. We hypothesized that predialysis VExUS findings would correlate more closely with cardiac and pulmonary congestion markers than with BCM-defined fluid overload.

Methods

This exploratory, single-center, observational study (October 2025) included 32 chronic HD patients presenting above their dry weight. We performed baseline echocardiography and Bioimpedance Spectroscopy (BCM). VExUS, Focused Cardiac Ultrasound (FOCUS), and Lung Ultrasound (LUS) were measured pre-HD, mid-HD, and post-HD.

Results

A total of 32 patients were included, of whom 8 (25%) had an anormal VEXUS score (1 grade 1, 1 grade 2 and 6 grade 3). There were no significant differences in baseline clinical characteristics or volumen-related between groups, including age, time on dialysis, comorbidities, predialysis weight,BCM defined fluid overload VExUS 0: 2.3kg, VExUS abnormal: 2.8kg-, total ultrafiltration (UF), pre- and post-HD blood pressure, interdialytic weight gain, or intradialytic hypotension events. However patients with abnormal VExUS findings exhibited greater LUS scores, and markers of impaired cardiac function, particularly RV dysfunction (p < 0.05). In patients with VExUS abnormal, scores improved during fluid removal without immediate rebound.
Significant correlations were found between VExUS and echocardiographic markers including RV S’ (ρ=-0.573, p=0.001), TAPSE (ρ=-0.396, p=0.025) and LVOT VTI (ρ=-0.408, p=0.020).

Conclusion

In this exploratory HD cohort, VExUS showed limited association with BCM-defined fluid overload but correlated with echocardiographic and pulmonary congestion markers, particularly indices of RV dysfunction. These findings suggest VExUS may reflect cardiorenal hemodynamic interaction rather than isolated intravascular volume excess. VExUS may therefore be most useful when integrated with clinical assessment, LUS, and focused echocardiography rather than an isolated ultrafiltration target.