Abstract: SA-PO1084
High Prevalence of Subclinical Congestion Detected by Multiorgan Point-of-Care Ultrasonography in Patients on Hemodialysis: Implications for Dry Weight Management
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
- Martinez Vaquera, Shaira, Diaverum Spain, Renal Services, Madrid, Spain
- Molina, Sonia Caparros, Diaverum Spain, Renal Services, Madrid, Spain
- Martinez Sanchez, Teresa, Diaverum Spain, Renal Services, Madrid, Spain
Background
Volume assessment in hemodialysis (HD) remains challenging, particularly for detection of subclinical congestion. Point-of-care ultrasound (PoCUS), including lung ultrasound (LUS), inferior vena cava (IVC), and portal Doppler assessment, may provide an integrated evaluation of fluid overload beyond conventional clinical examination. We evaluated the utility of longitudinal multiorgan PoCUS monitoring for congestion detection and dry weight management in HD patients.
Methods
Prospective descriptive study including 10 chronic HD patients with difficult dry weight adjustment or poor ultrafiltration tolerance. Weekly PoCUS assessments were performed over 5 weeks during the final hour of the midweek HD session. Evaluations included LUS, IVC measurements, portal Doppler, blood pressure, and clinical parameters. Pulmonary congestion was defined as ≥3 B-lines in at least two bilateral lung zones. Intravascular congestion was assessed by IVC diameter >2.1 cm with collapsibility <50% and portal pulsatility. Patients were classified as having no congestion, tissue congestion, or mixed congestion. Findings guided progressive dry weight adjustments (±0.5 kg) with serial reassessment.
Results
A total of 50 ultrasound evaluations were performed. Congestion was identified in 38% of assessments, including tissue congestion (20%) and mixed congestion (18%). Most congestion episodes (84%) were clinically silent. Seven dry weight adjustments and six additional dialysis sessions were prescribed based on PoCUS findings. Longitudinal follow-up demonstrated progressive improvement in ultrasound congestion patterns following intervention.
Conclusion
Multiorgan PoCUS monitoring identified a high burden of predominantly subclinical congestion in HD patients, highlighting limitations of conventional clinical assessment. Integrated pulmonary and venous ultrasound assessment may facilitate individualized dry weight management and improve recognition of occult fluid overload in outpatient HD care.