Utility of the Inferior Vena Cava Diameter as a Marker of Dry Weight in Nonoliguric Hemodialyzed Patients

Abstract

We have previously reported that the maximal inferior vena cava (IVC) diameter during quiet expiration (IVCe) measured by ultrasonography correlates well with the amount of body fluid, especially the circulating blood volume(2) and proposed using the criteria of IVC diameter to determine dry weight (DW) in anuric hemodialyzed (HD) patients: standard IVCe of pre- and post-HD are 14.9 +/- 0.4 and 8.2 +/- 0.3 mm, respectively (1). However, the same post-HD IVC criterion should not be applied to nonoliguric HD patients because it could result in rapid deterioration of residual renal function due to forced dehydration. Although the biochemical DW marker plasma atrial natriuretic peptide (ANP) is useful to evaluate hypervolemia but not hypovolemia, both hyper- and hypovolemia can be detected by IVC measurement. In the present study, we investigated whether the IVC diameter serves as an optimal evaluation of DW in nonoliguric HD (NO-HD) patients, avoiding not only overhydration but also dehydration. The IVCe and plasma ANP levels were measured in 14 euvolemic patients with chronic renal failure at conservative period (CP-CRF) and 11 NO-HD patients, in whom the average daily urine volume was more than 500 ml/day. In NO-HD patients, DW was adjusted to attain the euvolemic state with normotensive blood pressure, lack of edema, and lack of temporal oliguria after HD. The ANP in CP-CRF patients was 109.3 +/- 15.3 pg/ml, and pre- and post-HD ANP levels in NO-HD patients were 145.3 +/- 23.5 and 97.5 +/- 13.5 pg/ml, respectively. IVCe in CP-CRF was 13.4 +/- 0.9 mm, and pre- and post-HD IVCe in NO-HD patients were 14.2 +/- 1.0 mm and 11.9 +/- 0.9 mm, respectively. Although the post-HD IVCe was greater (i.e., less hypovolemic) than that in anuric HD patients, and close to the IVCe in CP-CRF, pre-HD IVCe was comparable with that in anuric HD patients. In addition, the pre-HD ANP level was no higher than that in CP-CRF. Thus, in NO-HD patients, the post-IVCe of 11.9 +/- 0.9 mm would be a marker for an appropriate DW setting avoiding severe post-HD dehydration as well as excessive hypervolemia during the interdialytic period.

Diagnostic accuracy of a simple ultrasound measurement to estimate central venous pressure in spontaneously breathing, critically ill patients

“…9 Previous attempts at noninvasive hemodynamic monitoring using plethysmography, thoracic electrical bioimpedance, and external Doppler probes have shown these methods to be cumbersome or inaccurate. [10][11][12][13] Other investigators have used echocardiography 14,15 and handheld ultrasound 16 to image the diameter of the inferior vena cava in order to assess intravascular volume status, but these techniques require expertise in sonographic imaging. An alternative technique is to measure peripheral venous pressure, which correlates with CVP.…”

Bedside Limited Echocardiography by the Emergency Physician Is Accurate During Evaluation of the Critically Ill Patient

“…[45][46][47][48] IVC dimensions, as measured by US, have been shown to provide useful information about right atrial pressure and baseline blood volume in patients who undergo hemodialysis. 49,50 In a study of adult volunteers before and after blood donation, measurement of IVC diameter was noted to be a reliable indicator of blood loss. 51 We are not aware of any previous data from the pediatric emergency medicine literature addressing the role of BLEEP.…”

Development and Validation of Bioimpedance Analysis Prediction Equations for Dry Weight in Hemodialysis Patients

“…To address these shortcomings, much research effort has been expended on the search for an objective measurement of fluid status that provides a common standard against which patients may be compared (1,2,6). Blood volume monitoring (2,7), ultrasound assessment of inferior vena cava diameter (2,8), and several biochemical parameters, such as brain or atrial natriuretic peptide (9), have been shown not to give an accurate estimate of DW (1,2). For more than 20 yr, bioelectrical impedance analysis (BIA) has been recognized as a noninvasive and simple technique to measure body hydration status of patients and has gained much attention for the determination of DW in HD patients (10 -13).…”