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Usefulness of US imaging in overhydrated nephropathic patients

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Abstract

Achievement of a normal hydration status is one of the major targets of hemodialysis. It is based on the estimation of “dry weight”, the term used to define normal body fluid content. The concept of dry weight in hemodialysis patients is clinically undisputed, but it is not always easy to achieve in this population. Assessment of hydration status by clinical evaluation is imprecise and often unreliable. Measurement of the inferior vena cava (IVC) diameter has been shown to reflect individual fluid status. The relationship between variation in IVC diameter before and after hemodialysis session and weight loss has been investigated. Ultrasound (US) measurement of the IVC diameter is considered a valid measure of the hydration status and is routinely used in hemodialysis patients. Moreover, a relationship between IVC diameter, respiratory activity and hydration status, evaluated by considering both plasma volume and central venous pressure, has been demonstrated. In conclusion, assessment of hydration status based on blood pressure and central venous pressure can be considered reliable only in patients without signs of heart failure.

Sommario

Il raggiungimento di un normale stato di idratazione è di fondamentale importanza nei pazienti in emodialisi e si basa sulla stima del “peso secco”, che indica il normale contenuto corporeo di fluidi. Il “peso secco” non è sempre facile da ottenere in questa popolazione di pazienti. La valutazione clinica dello stato di idratazione è spesso imprecisa e talvolta inaffidabile. Il diametro della vena cava inferiore (VCI) sembra riflettere lo stato di idratazione del paziente. La relazione tra la variazione del diametro della VCI prima e dopo la seduta emodialitica e la perdita di peso è già stata studiata. La misurazione ecografica del diametro della VCI è un valido strumento per la stima dello stato di idratazione ed è utilizzato quotidianamente nei pazienti in emodialisi. Inoltre, è stata dimostrata una relazione tra il diametro della VCI, l’attività respiratoria e lo stato di idratazione, considerando sia il volume plasmatico che la pressione venosa centrale. Concludendo, la valutazione dello stato di idratazione, basata sulla pressione arteriosa e sulla pressione venosa centrale, può essere considerata affidabile solo nei paziente senza scompenso cardiaco.

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Conflict of interest

The authors (Michele Prencipe, Antonio Granata, Alessandro D’Amelio, Giulia Romano, Filippo Aucella, Fulvio Fiorini) have no conflict of interest.

Ethical statements

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the Helsinki Declaration of 1975 and its late amendments

Human and animal studies

The study described in this article does not contain studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Nephrology and Dialysis Unit, “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo, Foggia, Italy

    Michele Prencipe & Filippo Aucella

  2. Nephrology and Dialysis Unit, “St. Giovanni di Dio” Hospital, C.da Consolida, 92100, Agrigento, Italy

    Antonio Granata

  3. Nephrology and Dialysis Unit, “Vito Fazzi” Hospital, Lecce, Italy

    Alessandro D’Amelio

  4. Internal Medicine Unit, AOU “Vittorio Emanuele-Policlinico”, Catania, Italy

    Giulia Romano

  5. Nephrology and Dialysis Unit, “S. M. della Misericordia” Hospital, ASL 18, Rovigo, Italy

    Fulvio Fiorini

  6. Advanced School of Ultrasonography in Nephrology - SIUMB, Milan, Italy

    Antonio Granata & Fulvio Fiorini

Authors
  1. Michele Prencipe
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  2. Antonio Granata
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  3. Alessandro D’Amelio
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  4. Giulia Romano
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  5. Filippo Aucella
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  6. Fulvio Fiorini
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Corresponding author

Correspondence to Antonio Granata.

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On behalf of the Uro-Nephrology Study Group/SIUMB.

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Prencipe, M., Granata, A., D’Amelio, A. et al. Usefulness of US imaging in overhydrated nephropathic patients. J Ultrasound 19, 7–13 (2016). https://doi.org/10.1007/s40477-014-0152-z

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  • DOI: https://doi.org/10.1007/s40477-014-0152-z

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