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The management of decongestion in patients undergoing hemodialysis has long posed a significant challenge due to the potential adverse effects of ultrafiltration. Adequate assessment of vascular filling capacity and volume status is essential to mitigate these risks. Currently, various tools are available for estimating absolute blood volume through dilution methods, assessing plasma refilling rate (PRR), and utilizing the venous excess ultrasound (VexUS) score. However, little evidence exists regarding the relationship between these evaluations during ultrafiltration in hemodialysis sessions.
The objective of this study is to present a case series of 9 patients whose vascular filling, PRR, and VexUS score measurements were recorded during hemodialysis sessions, in order to explore the relationship between these parameters and their clinical implications. Additionally, the study aims to examine the impact of these parameters on guiding ultrafiltration.
The study included patients with diverse diagnoses and undergoing hemodiafiltration, all of whom underwent ultrafiltration of at least 1000 ml.
Among the patients included in the study, 77.8% were female, and the same percentage were treated with hemodiafiltration. The mean age of the patients was 44.3 years (+/- 16.9). All patients exhibited volume overload, which was the primary indication for ultrafiltration. Notably, no intradialytic hypotension events were observed, even with the use of high ultrafiltration rates (>13 ml/kg/hr).
The assessment of PRR:UFR offers valuable insight into vascular filling capacity and aids in evaluating the persistence of congestion through the VexUS score. This information enables the adjustment of ultrafiltration rates, potentially contributing to the reduction of intradialytic morbid events. Therefore, integrating these parameters into clinical practice may be beneficial in optimizing ultrafiltration and improving patient outcomes during hemodialysis.