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Relationship of inferior vena cava collapsibility to ultrafiltration volume achieved in critically ill hemodialysis patients.
Int J Nephrol Renovasc Dis. 2018; 11:195-209.IJ

Abstract

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.

Authors+Show Affiliations

Division of Nephrology, Loma Linda University Medical Center, Loma Linda, CA, USA. Division of Nephrology, University of Southern California, Los Angeles, CA, USA, ekaptein@usc.edu.Division of Nephrology, University of Southern California, Los Angeles, CA, USA, ekaptein@usc.edu.Division of Nephrology, University of Southern California, Los Angeles, CA, USA, ekaptein@usc.edu.Division of Nephrology, University of Southern California, Los Angeles, CA, USA, ekaptein@usc.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30087575

Citation

Kaptein, Matthew J., et al. "Relationship of Inferior Vena Cava Collapsibility to Ultrafiltration Volume Achieved in Critically Ill Hemodialysis Patients." International Journal of Nephrology and Renovascular Disease, vol. 11, 2018, pp. 195-209.
Kaptein MJ, Kaptein JS, Oo Z, et al. Relationship of inferior vena cava collapsibility to ultrafiltration volume achieved in critically ill hemodialysis patients. Int J Nephrol Renovasc Dis. 2018;11:195-209.
Kaptein, M. J., Kaptein, J. S., Oo, Z., & Kaptein, E. M. (2018). Relationship of inferior vena cava collapsibility to ultrafiltration volume achieved in critically ill hemodialysis patients. International Journal of Nephrology and Renovascular Disease, 11, 195-209. https://doi.org/10.2147/IJNRD.S165744
Kaptein MJ, et al. Relationship of Inferior Vena Cava Collapsibility to Ultrafiltration Volume Achieved in Critically Ill Hemodialysis Patients. Int J Nephrol Renovasc Dis. 2018;11:195-209. PubMed PMID: 30087575.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship of inferior vena cava collapsibility to ultrafiltration volume achieved in critically ill hemodialysis patients. AU - Kaptein,Matthew J, AU - Kaptein,John S, AU - Oo,Zayar, AU - Kaptein,Elaine M, Y1 - 2018/07/23/ PY - 2018/8/9/entrez PY - 2018/8/9/pubmed PY - 2018/8/9/medline KW - acute kidney injury KW - chronic kidney disease KW - critical illness KW - end-stage renal disease KW - inferior vena cava ultrasound KW - intermittent hemodialysis/ultrafiltration KW - intradialytic hypotension KW - intravascular volume SP - 195 EP - 209 JF - International journal of nephrology and renovascular disease JO - Int J Nephrol Renovasc Dis VL - 11 N2 - 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. SN - 1178-7058 UR - https://www.unboundmedicine.com/medline/citation/30087575/Relationship_of_inferior_vena_cava_collapsibility_to_ultrafiltration_volume_achieved_in_critically_ill_hemodialysis_patients_ L2 - https://dx.doi.org/10.2147/IJNRD.S165744 DB - PRIME DP - Unbound Medicine ER -
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