VENOUS EXCESS ULTRASOUND SCORE (VEXUS) TO GUIDE DECONGESTION IN UREMIC CARDIOMYOPATHY WITH SEVERE LEFT VENTRICULAR SYSTOLIC DYSFUNCTION IN A PATIENT UNDERGOING A KIDNEY TRANSPLANT

E-Poster

Abstract Title

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Corona-Deschamps

Co-author 1

Alejandro Rojas Montaño draalejandrorojasm@gmail.com Angeles Del Pedregal Nephrology Mexico city

Co-author 2

Lucero Salgado Ambrosio Dra.lusalga2@gmail.com Angeles Del Pedregal Nephrology Mexico city

Co-author 3

Cesar Adolfo Nieves nievescesar96@gmail.com Angeles Del Pedregal Internal Medicine Mexico City

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Introduction

Congestive heart failure is more prevalent in patients with end-stage renal disease (ESRD) than in the general population. Left ventricular hypertrophy leading to impaired systolic function in patients with ESRD is called uremic cardiomyopathy. Venous excess ultrasound score (VExUS) is a scoring system that quantifies systemic congestion. The case discussed here highlights a novel application of VExUS in a postoperative patient with a severely impaired LV systolic function secondary to uremic cardiomyopathy whose kidney transplant (KT) was guided by VExUS.

Methods

Case Description

Results

A 56-year-old man with a history of diabetes, hypertension, chronic kidney disease with hemodialysis for 3 years, 3 times per week, and congestive heart failure secondary to uremic cardiomyopathy with left ventricular systolic function (LVSF) of 36%, New York Heart Association (NYHA) functional class 2, without coronary artery disease, underwent a related KT in 2023. In a preoperative assessment, a point-of-care ultrasound (POCUS) showed that the inferior venous cava (IVC) diameter was <2 cm with >50% collapsibility and VExUS 0 (Figure 1). Thus, the plan was to perform a POCUS tid after KT.

The KT was performed without complications. The postoperative fluid balance was +2000 ml and in the first POCUS post-KT showed an IVC diameter >2 cm, portal vein (PV) pulsatility >50%, and normal hepatic veins (Hvs) with a VExUS 1 (Figure 2). The patient remained without any clinically evident signs of congestion. Due to the findings of the first POCUS post-KT, we decided to stop 1:1 fluid reposition for 8 hours, and after a second POCUS post-KT, we restarted fluid reposition at 1:0.5 relation. We continued performing POCUS tid until discharge and guiding treatment decisions based on POCUS’ findings. The patient was discharged on day +5 post-KT. On day +12 after KT, a new echocardiogram was performed showing a considerable improvement of LVSF to 62%.

Conclusions

VExUS is an ultrasound-guided modality that can detect congestion even before it is clinically evident. This is very significant in patients with high cardiac risk and complex scenarios like in patients with HF who will undergo KT. Guiding fluid reposition with POCUS can reduce the risk of postoperative congestive heart failure and most importantly can help increase the feasibility of performing KT in patients with advanced heart failure.

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