Inferior Vena Cava Collapsibility Index: Clinical Validation and Application for Assessment of Relative Intravascular Volume

Kaptein, Matthew J; Kaptein, Elaine M.

doi:10.1053/j.ackd.2021.02.003

Cited by 29 publications

(31 citation statements)

References 66 publications

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“…Initial exclusion criteria adapted from the Practice Guidelines by the American Association for the Study of Liver Diseases [ 1 ] included documentation of potential causes of AKI other than HRS-AKI such as: (1) recent cardiopulmonary arrest, hypotension with vasopressor support, (2) current or recent use of nephrotoxic agents, (3) evidence of glomerulonephritis or interstitial nephritis, and/or (4) urinary tract obstruction. Other exclusion criteria included: (5) IVC thrombosis, (6) CKD stage 4 or 5 or maintenance dialysis therapy prior to or at the time of IVC US, (7) preexisting acute decompensated heart failure or severe cardiac valvular disease, which may alter IVC US findings [ 10 ] and also impair renal function, and/or (8) patients who had not received the standardized albumin administration and diuretic withdrawal prior to the IVC US. Thirty one patients were excluded based on these criteria.…”

Section: Methodsmentioning

confidence: 99%

“…At the time of the nephrology consultation, all patients had bedside US evaluation in a semi-recumbent position at an incline of 30–45 degrees without Valsalva or sniff maneuvers using a portable US machine (LOGIQ e B12, GE Healthcare, Wauwatosa, WI 53226) as previously described [ 10 ]. The heart was viewed to assess contractility and whether a pericardial effusion was present.…”

Section: Methodsmentioning

confidence: 99%

“…Patients with very small IVCmax values (≤0.7 cm) may have small changes in IVC diameters with respiration and still may be hypovolemic [ 11 ]. If the IVC CI was ≥50% or the IVCmax was ≤0.7 cm, suggesting hypovolemia [ 10 , 11 ], additional volume administration was recommended as clinically indicated and documented as received. If the IVC CI was <20% and the IVCmax was >0.7 cm, suggesting intravascular volume overload [ 10 , 11 ], volume as saline, albumin and/or blood products was restricted, and diuretics, therapeutic paracentesis, and/or ultrafiltration were recommended and received as clinically indicated.…”

Section: Methodsmentioning

confidence: 99%

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Hepatorenal syndrome misdiagnosis may be reduced using inferior vena cava ultrasound to assess intravascular volume and guide management

Kaptein

2023

Renal Failure

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Hepatorenal syndrome (HRS) is a diagnosis of exclusion defined as acute kidney injury (AKI) with cirrhosis and ascites, with serum creatinine unresponsive to standardized volume administration and diuretic withdrawal. Persistent intravascular hypovolemia or hypervolemia may contribute to AKI and be revealed by inferior vena cava ultrasound (IVC US), which may guide additional volume management. Twenty hospitalized adult patients meeting HRS-AKI criteria had IVC US to assess intravascular volume after receiving standardized albumin administration and diuretic withdrawal. Six had IVC collapsibility index (IVC-CI) ≥50% and IVCmax ≤0.7 cm suggesting intravascular hypovolemia, 9 had IVC-CI <20% and IVCmax >0.7 cm suggesting intravascular hypervolemia, and 5 had IVC-CI ≥20% to <50% and IVCmax >0.7 cm. Additional volume management was prescribed in the 15 patients with either hypovolemia or hypervolemia. After 4–5 days, serum creatinine levels decreased ≥ 20% without hemodialysis in 6 of 20 patients – 3 with hypovolemia received additional volume, and 2 with hypervolemia plus one with ‘euvolemia’ and dyspnea were volume restricted and received diuretics. In the other 14 patients, serum creatinine failed to persistently decrease ≥20% or hemodialysis was required indicating that AKI did not improve. In summary, fifteen of 20 patients (75%) were presumed to have intravascular hypovolemia or hypervolemia by IVC ultrasound. Six of the 20 patients (40%) improved AKI by 4-5 days of follow-up with additional IVC US-guided volume management, and thus had been misdiagnosed as HRS-AKI. IVC US may more accurately define HRS-AKI as being neither hypovolemic nor hypervolemic, and guide volume management, decreasing the frequency of HRS-AKI misdiagnosis.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Hepatorenal syndrome misdiagnosis may be reduced using inferior vena cava ultrasound to assess intravascular volume and guide management

Kaptein

2023

Renal Failure

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“…This is measured 2-4 cm from the cavoatrial junction and is calculated as: CI=(IVC maximum-IVC minimum)/IVC maximum, with maximum and minimum values measured through the respiratory cycle. Studies have various thresholds for predicting fluid responsiveness and range from a CI of 12% to 42% (37). Overall, the CI has moderate predictive utility of fluid responsiveness in patients who are mechanically ventilated, but only fair predictive utility (poor sensitivity) in patients with spontaneous breathing, in part due to irregular or large swings in intrathoracic pressure (38).…”

Section: Ribsmentioning

confidence: 99%

How to Determine Fluid Management Goals during Continuous Kidney Replacement Therapy in Patients with AKI: Focus on POCUS

2022

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The utilization of kidney replacement therapies (KRT) for fluid management of patients who are critically ill has significantly increased over the last years. Clinical studies have suggested that both fluid accumulation and high fluid removal rates are associated with adverse outcomes in the critically ill population receiving KRT. Importantly, the ideal indications and/or fluid management strategies that could favorably affect these patients are unknown; however, differentiating clinical scenarios in which effective fluid removal may provide benefit to the patient by avoiding congestive organ injury, compared with other settings in which this intervention may result in harm, is direly needed in the critical care nephrology field. In this review, we describe observational data related to fluid management with KRT, and examine the role of point-of-care ultrasonography as a potential tool that could provide physiologic insights to better individualize decisions related to fluid management through KRT.

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“…Inferior vena cava diameter (IVCD) and collapsibility index have been proposed to monitor intravascular volume and right atrial pressure or central venous pressure changes in dialysis patients with positive outcomes (92). However, the practical difficulty in implementing these methods, factors affecting reading and the poor predictive value on blood pressure response in probing dry weight have precluded its generalizability in chronic patients setting (93).…”

Section: Instrumental Toolsmentioning

confidence: 99%

Sodium First Approach, to Reset Our Mind for Improving Management of Sodium, Water, Volume and Pressure in Hemodialysis Patients, and to Reduce Cardiovascular Burden and Improve Outcomes

Canaud¹,

Kooman²,

Maierhofer³

et al. 2022

Front. Nephrol.

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New physiologic findings related to sodium homeostasis and pathophysiologic associations require a new vision for sodium, fluid and blood pressure management in dialysis-dependent chronic kidney disease patients. The traditional dry weight probing approach that has prevailed for many years must be reviewed in light of these findings and enriched by availability of new tools for monitoring and handling sodium and water imbalances. A comprehensive and integrated approach is needed to improve further cardiac health in hemodialysis (HD) patients. Adequate management of sodium, water, volume and hemodynamic control of HD patients relies on a stepwise approach: the first entails assessment and monitoring of fluid status and relies on clinical judgement supported by specific tools that are online embedded in the HD machine or devices used offline; the second consists of acting on correcting fluid imbalance mainly through dialysis prescription (treatment time, active tools embedded on HD machine) but also on guidance related to diet and thirst management; the third consist of fine tuning treatment prescription to patient responses and tolerance with the support of innovative tools such as artificial intelligence and remote pervasive health trackers. It is time to come back to sodium and water imbalance as the root cause of the problem and not to act primarily on their consequences (fluid overload, hypertension) or organ damage (heart; atherosclerosis, brain). We know the problem and have the tools to assess and manage in a more precise way sodium and fluid in HD patients. We strongly call for a sodium first approach to reduce disease burden and improve cardiac health in dialysis-dependent chronic kidney disease patients.

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Inferior Vena Cava Collapsibility Index: Clinical Validation and Application for Assessment of Relative Intravascular Volume

Cited by 29 publications

References 66 publications

Hepatorenal syndrome misdiagnosis may be reduced using inferior vena cava ultrasound to assess intravascular volume and guide management

Hepatorenal syndrome misdiagnosis may be reduced using inferior vena cava ultrasound to assess intravascular volume and guide management

How to Determine Fluid Management Goals during Continuous Kidney Replacement Therapy in Patients with AKI: Focus on POCUS

Sodium First Approach, to Reset Our Mind for Improving Management of Sodium, Water, Volume and Pressure in Hemodialysis Patients, and to Reduce Cardiovascular Burden and Improve Outcomes

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