Study of Lung Ultrasound and Caval Indices to Assess Volume Status in Maintenance Hemodialysis Patients

Background: Point of care ultrasound (POCUS) is a useful technique for determining volume status. Lung POCUS is a radiation-free, non-invasive technique that can help determine dry weight, estimate extravascular lung water (EVLW), and identify pulmonary congestion before it becomes clinically noticeable. This study aimed to evaluate the utility of POCUS parameters in assessing volume status among end-stage kidney disease (ESKD) patients on maintenance hemodialysis (HD). Methods: This cross section study was conducted at the outpatient hemodialysis unit at Zagazig University Hospital and Alshorouk General Hospital on 60 ESKD patients on maintenance HD. Lung ultrasound was measured in all cases. Results: The most striking findings of our study regarding ultrasound parameters of volume status were related to the assessment of B-lines. During the first visit, 80% of patients presented with more than three B-lines pre-dialysis, which decreased to 50% post-dialysis. In the second assessment, 50% of patients had more than three B-lines pre-dialysis, but this number significantly dropped to 26.7% after dialysis. Conclusion: Point-of-care ultrasound is a valuable tool for objective assessment of volume status in hemodialysis patients, capable of detecting subclinical volume overload even in the absence of physical signs. The significant improvements observed in ultrasound parameters (B-lines, IVC diameter, and IVC collapsibility) between first and second assessments validate its utility in guiding volume management.