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Relationship of inferior vena cava collapsibility to ultrafiltration volume achieved in critically ill hemodialysis patients

Authors Kaptein MJ, Kaptein JS, Oo Z, Kaptein EM

Received 16 February 2018

Accepted for publication 9 May 2018

Published 23 July 2018 Volume 2018:11 Pages 195—209


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Pravin Singhal

Matthew J Kaptein,1,2 John S Kaptein,2 Zayar Oo,2 Elaine M Kaptein2

1Division of Nephrology, Loma Linda University Medical Center, Loma Linda, CA, USA; 2Division of Nephrology, University of Southern California, Los Angeles, CA, USA

Background: Ultrasound (US) assessment of intravascular volume may improve volume management of dialysis patients. We investigated the relationship of intravascular volume evaluated by inferior vena cava (IVC) US to net volume changes with intermittent hemodialysis (HD) in critically ill patients.
Methods: A retrospective cohort of 113 intensive care unit patients in 244 encounters had clinical assessment of intravascular volume followed by US of respiratory/ventilatory variation of IVC diameter, and had HD within 24 h. IVC collapsibility index (IVC CI)=(IVCmax–IVCmin)/IVCmax*100%. Volume management was guided by clinical data plus IVC US findings. Intradialytic hypotension (IDH) was categorized by severity from none to inability to tolerate HD.
Results: Linear regression correlating n-weighted proportions of encounters achieving net volume removal of ≥0.5 L, ≥1.0 L, ≥1.5 L, and ≥2.0 L strongly correlated across the range of IVC CI (R2=0.87–0.64). Sensitivity and specificity analysis showed IVC CI was a better predictor than IVCmax of achieving net ultrafiltration (UF) volumes. Mean central venous pressure, pulmonary artery occlusion pressure, and cardiac output were poor predictors by logistic regression and receiver operating curve analyses. IVC CI <20% was the approximate optimal cutoff for achieving ≥0.5 L to ≥2.0 L net UF volumes. Net volume change achieved tended to be less than recommended and may have been limited by the development of IDH. Severity of IDH did not correlate with UF rate in mL/kg/h. χ2 analysis showed pre-US clinical intravascular volume assessments had poor concordance with IVC CI categories.
Conclusion: IVC US may be a useful tool for predicting whether critically ill patients will achieve volume removal with HD.

Keywords: inferior vena cava ultrasound, intravascular volume, intradialytic hypotension, intermittent hemodialysis/ultrafiltration, critical illness, end-stage renal disease, chronic kidney disease, acute kidney injury

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