A Prospective Non-Randomised Interventional Study of Goal-Directed Ultrafiltration Compared With Clinical Dry-Weight Assessment in Achieving Euvolemic Status of Patients on Maintenance Hemodialysis

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Pankaj Ganvir
C.H. Sudhiranjan Dash https://orcid.org/0000-0002-4123-6373
Amjad Khan Pathan
Rushi Deshpande
Ashay Shingare
Madan Mohan Bahadur
Ashwin Patil


B-lines, dry weight assessment, hemodialysis, inferior vena cava collapsing index (IVCCI), left ventricular hypertrophy


An accurate assessment of intravascular volume status in hemodialysis (HD) patients presents a significant challenge. Current clinical practices to determine dry weight is flawed due to interobserver variability and nonreproducibility. This miscalculation results in either chronic hypervolemia or hypovolemia with intra or interdialytic hypotension. The quest for noninvasive volume assessment tools to aid in the estimation of dry weight still continues. This study aims at goal-directed ultrafiltration removal compared with clinical dry-weight assessment in achieving euvolemic status of patients on chronic HD. It is a prospective, single-centered, nonrandomized, noninvasive interventional study on HD patients, for 12 months. Fifty two patients participated out of which 46 completed the study. Ultrasound-guided inferior vena cava collapsing index (IVCCI) and B lines were measured at intervals along with cardiac parameters. Dry weight was first estimated clinically by trial and error method. New dry weight target was set when B-lines were less than four in the eight site lung ultrasound and IVCCI between 50 and 75%, after 30 min post dialysis. Approximately 23.9% of the patients did not require dry-weight modification throughout the study. About 19% patients did not achieve dry weight in spite of all interventions. Overall, 56.5% of the patients achieved dry weight during the study period. A total of 46.3% of patients with NYHA Grade 3 dyspnoea observed at the start of study was reduced to 2.2%, showing statistical significance. Clinical assessment when bundled with noninvasive technology of assessment of dry weight showed encouraging results. B-lines and IVCCI estimation could be additional tools to achieve target weight goals, reducing complications and increasing compliance.

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1. Daugirdas JT, Blake PG, Ing TS. First Indian Reprint. 5th ed. Philadelphia, USA: Wolter Kluwer Heath; 2015. Handbook of Dialysis; pp. 205–6.

2. Arkouche W, Giaime P, Mercadal L. Les membres de la commission de dialyse de la Société de néphrologie. [Fluid overload and arterial hypertension in hemodialysis patients]. Nephrol Ther. 2013;9:408–15. 10.1016/j.nephro.2013.04.004

3. Allinovi M, Saleem MA, Burgess O, Armstrong C, Hayes W. Finding covert fluid: Methods for detecting volume overload in children on dialysis. Pediatr Nephrol Berl Ger. 2016;31:2327–35. 10.1007/s00467-016-3431-4

4. Di Nicolò P, Magnoni G, Granata. Lung ultrasound in hemodialysis: A card to be played. Blood Purif. 2017;44(1):1–7. 10.1159/000457897

5. Ilyas A, Ishtiaq W, Assad S, et al. Correlation of IVC diameter and collapsibility index with central venous pressure in the assessment of intravascular volume in critically Ill patients. Cureus. 2017;9(2):e1025. 10.7759/cureus.1025

6. Yildirimturk O, Tayyareci Y, Erdim R, Ozen E, Yurdakul S, Aytekin V, et al. Assessment of right atrial pressure using echocardiography and correlation with catheterization. J Clin Ultrasound. 2011;39(6):337–43. 10.1002/jcu.20837

7. Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990;66(4):493–6. 10.1016/0002-9149(90)90711-9

8. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis. 1998;32(Suppl 3):S112–9. 10.1053/ajkd.1998.v32.pm9820470

9. Wanner C, Krane V, März W, Olschewski M, Asmus HG, Krämer W, et al. Randomized controlled trial on the efficacy and safety of atorvastatin in patients with type 2 diabetes on hemodialysis (4D study): Demographic and baseline characteristics. Kidney Blood Press Res. 2004;27(4):259–66. 10.1159/000080241

10. Arun Thomas ET, Mohandas MK, George J. Comparison between clinical judgment and integrated lung and inferior vena cava ultrasonography for dry weight estimation in hemodialysis patients. Hemodial Int. 2019;23(4):494–503. 10.1111/hdi.12762

11. Tiba MH, Belmont B, Heung M, Theyyunni N, Huang RD, Fung CM, et al. Dynamic limb bioimpedance and inferior vena cava ultrasound in patients undergoing hemodialysis. ASAIO J. 2016;62:463–9. 10.1097/MAT.0000000000000355

12. Noble VE, Murray AF, Capp R, Sylvia-Reardon MH, Steele DJR, Liteplo A. Ultrasound assessment for extravascular lung water in patients undergoing hemodialysis. Time course for resolution. Chest. 2009;135:1433–9. 10.1378/chest.08-1811

13. Enia G, Torino C, Panuccio V, Tripepi R, Postorino M, Aliotta R, et al. Asymptomatic pulmonary congestion and physical functioning in hemodialysis patients. Clin J Am Soc Nephrol. 2013;8(8):1343–8. doi:10.2215/CJN.11111012

14. Annamalai I, Balasubramaniam S, Fernando ME, Srinivasaprasad ND, Suren S, Thirumalvalavan K, et al. Volume assessment in hemodialysis: A comparison of present methods in clinical practice with sonographic lung comets. Indian J Nephrol. 2019; 29(2):102–10. 10.4103/ijn.IJN_78_18

15. Loutradis C, Sarafidis PA, Ekart R, Papadopoulos C, Sachpekidis V, Alexandrou ME, et al. The effect of dry-weight reduction guided by lung ultrasound on ambulatory blood pressure in hemodialysis patients: A randomized controlled trial. Kidney Int. 2019;95(6):1505–13. 10.1016/j.kint.2019.02.018

16. Chan C, Floras JS, Miller JA, Pierratos A. Improvement in ejection fraction by nocturnal haemodialysis in end-stage renal failure patients with coexisting heart failure. Nephrol Dial Transplant. 2002;17(8):1518–21. 10.1093/ndt/17.8.1518

17. Hung KC, Lee CH, Chen CC, Chu CC, Wang CY, Hsieh IC, et al. Advanced left ventricular diastolic dysfunction in uremic patients with type 2 diabetes on maintenance hemodialysis. Circ J. 2012;76(10):2380–5. 10.1253/circj.cj-12-0471

18. Pecoits-Filho R, Bucharles S, Barberato S. Diastolic heart failure in dialysis patients: Mechanisms, diagnostic approach, and treatment. Semin Dial. 2012;25:35–41. 10.1111/j.1525-139X.2011.01011.x

19. Trinh E, Chan CT. Intensive home hemodialysis results in regression of left ventricular hypertrophy and better clinical outcomes. Am J Nephrol. 2016;44(4):300–7. 10.1159/000449452

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