The Ultrasound-Augmented Physical Exam for Nephrologists: Beyond the Kidney

Reisinger, Nathaniel; Ahmed, Nahreen

doi:10.1053/j.ackd.2021.10.005

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Further, social media can be harnessed as a force multiplier in clinical ultrasound education, allowing rapid training of personnel and allowing for remote crowd-sourced quality assurance [42 ▪ ]. Further advances such as cloud computing and ultrasound with fully integrated video chat interfaces facilitate remote mentorship, allowing faculty development across institutions [37 ▪ ,43]. These advances in faculty development will be the linchpin for the development of clinical ultrasound in coming years.…”

Section: Training In Clinician-performed Ultrasound: An Unmet Needmentioning

confidence: 99%

Current opinion in quantitative lung ultrasound for the nephrologist

Reisinger,

Koratala

2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review Volume overload mediates worse cardiovascular outcomes in patients with end-stage kidney disease (ESKD) on hemodialysis (HD), leading to increased acute care utilization. Understanding the presence of pulmonary congestion, which is often clinically silent, could be instrumental in predicting acute care needs and mitigating risks through appropriate therapy. This review provides an overview of the existing literature on lung ultrasound in ESKD patients. Recent findings Quantitative lung ultrasound predicts adverse cardiovascular outcomes in ESKD patients on HD. The largest randomized controlled trial of a lung ultrasound-guided ultrafiltration strategy demonstrated control of pulmonary congestion without an increased risk of intradialytic hypotension, arrhythmia, or access thrombosis. Despite this, the study was negative in the incidence of the primary composite endpoint of all-cause death, nonfatal myocardial infarction, and decompensated heart failure. A post hoc analysis showed promise with reductions in recurrent acute care utilization and cardiovascular events. Recent research has focused on simplification of the 28-zone lung ultrasound, and abbreviated protocols have been shown to retain prognostic ability. Summary Lung ultrasound is a valuable tool for nephrologists to diagnose and manage pulmonary congestion. However, its optimal integration with other hemodynamic parameters to formulate effective management strategies remains elusive. Future studies should address these gaps and find solutions to the training inadequacies in clinician-performed ultrasound.

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Section: Training In Clinician-performed Ultrasound: An Unmet Needmentioning

confidence: 99%

Current opinion in quantitative lung ultrasound for the nephrologist

Reisinger,

Koratala

2023

Current Opinion in Nephrology &Amp; Hypertension

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“…Over the past 25 years, POCUS has emerged as a powerful tool to improve clinicians’ diagnostic accuracy when evaluating patients in most specialties. In nephrology, POCUS is no longer confined to kidney ultrasound or procedural guidance but includes a broad range of applications, including assessment of volume status, cardiopulmonary disease, and venous thrombosis 2 , 3 . Most medical schools (78%) have integrated structured POCUS training into their preclinical and clinical curricula 4 , and 61% of internal medicine residency programs had a POCUS curriculum in 2020 5 .…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a Brief Point of Care Ultrasound Course at a National Nephrology Conference

Koratala,

Soni,

Mehta

et al. 2024

pocus

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The rising demand for point of care ultrasound (POCUS) instruction during fellowship has been limited due to a shortage of trained faculty and courses designed specifically for . A hands-on POCUS was organized during the April 2023 National Kidney Foundation (NKF) Spring Clinical Meeting to address this challenge. The course consisted of lectures and a 4-hour hands-on workshop guided by multidisciplinary POCUS experts. The anonymous post-course survey received responses from 25 out of 39 participants, yielding a 64.1% response rate. On a scale of 0-10, confidence levels for acquiring kidney images rose from 2.6 + 2.3 (mean + SD) to 7.8 + 1.5 post-workshop (p<0.001). Similarly, a remarkable improvement in confidence for acquiring lung and cardiac images was seen as scores increased from 1.8 + 2.4 to 7.7 + 1.5 (p<0.001) and from 1.5 + 2.2 to 7.2 + 1.3 (p<0.001), respectively. Additionally, respondents reported a substantial improvement in their confidence to interpret kidney, lung, and cardiac POCUS images, with scores increasing from 4.5 + 2.2 to 7.7 + 1.1 (p<0.001), 2.3 + 2.4 to 7.6 + 1.5 (p<0.001), and 2 + 2 to 7.3 + 1.5 (p<0.001), respectively. Barriers to implementing POCUS use at institutions included a perceived lack of trained faculty, limited protected time for faculty, and insufficient support from division leadership. The NKF POCUS successfully improved participants’ confidence in acquiring and interpreting basic POCUS images.

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“…Point-of-care ultrasound (POCUS) is an emerging core competency in nephrology (1). Indeed, discussion is ongoing about whether to add core POCUS competencies to the Accreditation Council for Graduate Medical Education (ACGME) requirements for nephrology training programs.…”

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confidence: 99%