P1059acould Inferior Vena Cava Diameter Reflect the Volume Status of the Patient With Intermittent Hemodialysis ?

Abstract

Background and Aims In 1960, Clyde shields (1st chronic hemodialysis patient) developed severe hypertension under treatment.His physician “Dr.scribner” decided to treat this complication using ultrafiltration to deplete the extracellular volume which was thought to be responsible for the increased blood pressure.It was successful, blood pressure decreased to normal and Clyde remained alive for 11 years.from these coming the rationale of dry body weight and its value in improving dialysis patient and improving his survival and decreasing his suffering. Several different techniques have been used to derive more standard methods of assessment dry weight, however optimal methods for adjusting fluid volume status and ideal dry weight remain uncertain. AIM To assess value of using IVC diameter and collapsibility index in modification of dry body weight in hemodialysis patient. Method A single center study included 98 patients hemodialysis patient unit in our center. all patients were subjected to assessment of IVC diameter before and after one hour of the first hemodialysis session of the week using ultrasound. We choose muscle cramps as an indicator for hypovolemia . Patients were allocated in two groups. Group 1 : patients with muscle cramps (hypotension) at last hour of session& Group 2 :without muscle cramps (normotensive or hypotensive) at last hour of session. Patients with other causes of muscle cramps rather than hypovolumia were excluded (e.g. hypocalcaemia, l-carnitine deficiency ,etc) . Results Patients with muscle cramps in last hour of session were 8 patients with average ivc diameter 0.7 cm & collapsibility more than 80%.Patients without muscle cramps in last hour of session were 84 patient with average ivc diameter 1.3 cm & collapsibility more than 50%. On interpretation of the eight patient :one patient had bilateral lower limb edema 2ry to local cause (varicose vein) not as a part of overload, three patient had uncontrolled blood pressure cannot tolerate more UF and was hypovolemic but on need to increase antihypertensive medication, two Patients had improved nutritional status with increased lean body mass, one patient had prepare for transplantation and during coarse of preparation NCCT chest showed bilateral diffuse ground glass opacities (overload versus interstitial lung disease). There was marked improvement, however NCCT still revealed ground glass opacities, in spite of patient become hypovolemic (clinically and confirmed by IVC diameter ), so patient investigated for the cause of interstitial lung disease and unfortunately diagnosed by further investigation as latent TB. Conclusions Using of ultrasound in assessment of IVC diameter is a promising method for estimating dry body weight in hemodialysis patient because it is simple, quick ,non-invasive and helpful especially in debatable cases. Conclusion Using of ultrasound in assessment of IVC diameter is a promising method for estimating dry body weight in hemodialysis patient because it is simple, quick ,non-invasive and helpful especially in debatable cases.