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. 2014 Apr 30;4(1):82-8.
doi: 10.1159/000362170. eCollection 2014 Jan.

Can Nephrologists Use Ultrasound to Evaluate the Inferior Vena Cava? A Cross-Sectional Study of the Agreement between a Nephrologist and a Cardiologist

José Muniz Pazeli  1 , Daniel Fagundes Vidigal  2 , Tarcísio Cestari Grossi  3 , Natália Maria Silva Fernandes  4 , Fernando Colugnati  4 , Rogério Baumgratz de Paula  4 , Hélady Sanders-Pinheiro  4
Affiliations

Can Nephrologists Use Ultrasound to Evaluate the Inferior Vena Cava? A Cross-Sectional Study of the Agreement between a Nephrologist and a Cardiologist

José Muniz Pazeli et al. Nephron Extra. .

Abstract

Background/aims: The costs and the need for a specialist impair the implementation of ultrasonography for evaluating the inferior vena cava (IVC) to assess the volemic status in hemodialysis patients. We investigated whether a nephrologist with limited ultrasound training can accurately assess the IVC in patients undergoing hemodialysis.

Methods: A cardiologist and a nephrologist consecutively measured the indexed IVC expiratory diameter (VCDi) and the IVC collapsibility index (IVCCI) of 52 patients during hemodialysis sessions. In protocol I, the nephrologist used a regular ultrasound system (RUS) and the cardiologist used a cardiovascular ultrasound equipment; in protocol II, the machines were interchanged. Pearson and kappa coefficients and the interexaminer agreement by the Bland-Altman method were calculated.

Results: The VCDi measurements showed a strong correlation in both protocols (r = 0.88 and 0.84 in protocols I and II, respectively). The volemic classifications were excellent in protocol I (kappa = 0.82 and 0.93 by VCDi and IVCCI, respectively) and substantial in protocol II (kappa = 0.77 and 0.75 by VCDi and IVCCI, respectively). The interexaminer agreement on the VCDi measurements was very good in both protocols.

Conclusions: Ultrasound evaluation of the IVC can be performed by nephrologists using an RUS to assess the volemic status in hemodialysis patients.

Keywords: Agreement; Fluid status; Hemodialysis; Inferior vena cava; Point-of-care ultrasonography.

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Figures

Fig. 1
Fig. 1
Design of the study. HD = Hemodialysis; CKD = chronic kidney disease.
Fig. 2
Fig. 2
The Bland-Altman graph.
See this image and copyright information in PMC

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