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

• Main Authors: José Muniz Pazeli, Daniel Fagundes Vidigal, Tarcísio Cestari Grossi, Natália Maria Silva Fernandes, Fernando Colugnati, Rogério Baumgratz de Paula, Hélady Sanders-Pinheiro
• Format: Article
• Language: English
• Published: Karger Publishers 2014-04-01
• Series: Nephron Extra
• Subjects: Agreement; Fluid status; Hemodialysis; Inferior vena cava; Point-of-care ultrasonography
• Online Access: http://www.karger.com/Article/FullText/362170

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.