Objective Methods of Assessing Fluid Status to Optimize Volume Management in Kidney Disease and Hypertension: The Importance of Ultrasound

Fluid overload, a prevalent complication in patients with renal disease and hypertension, significantly impacts patient morbidity and mortality. The daily clinical challenges that clinicians face include how to identify fluid overload early enough in the course of the disease to prevent adverse outc...

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Bibliographic Details
Published in:	Journal of clinical medicine Vol. 12; no. 19; p. 6368
Main Authors:	Patel, Sharad, Green, Adam, Ashokumar, Sandhya, Hoke, Andrew, Rachoin, Jean-Sebastien
Format:	Journal Article
Language:	English
Published:	Basel MDPI AG 01-10-2023 MDPI
Subjects:	Biomarkers Care and treatment Clinical medicine Complications and side effects Diagnosis Doppler effect Dropsy Dyspnea Edema Evaluation Health aspects Heart failure Hypertension Kidney diseases Mortality Osmoregulation Patients Review Risk factors Ultrasonic imaging Water-electrolyte balance (Physiology) United States
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Summary:	Fluid overload, a prevalent complication in patients with renal disease and hypertension, significantly impacts patient morbidity and mortality. The daily clinical challenges that clinicians face include how to identify fluid overload early enough in the course of the disease to prevent adverse outcomes and to guide and potentially reduce the intensity of the diuresis. Traditional methods for evaluating fluid status, such as pitting edema, pulmonary crackles, or chest radiography primarily assess extracellular fluid and do not accurately reflect intravascular volume status or venous congestion. This review explores the rationale, mechanism, and evidence behind more recent methods used to assess volume status, namely, lung ultrasound, inferior vena cava (IVC) ultrasound, venous excess ultrasound score, and basic and advanced cardiac echocardiographic techniques. These methods offer a more accurate and objective assessment of fluid status, providing real-time, non-invasive measures of intravascular volume and venous congestion. The methods we discuss are primarily used in inpatient settings, but, given the increased pervasiveness of ultrasound technology, some could soon expand to the outpatient setting.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1
ISSN:	2077-0383 2077-0383
DOI:	10.3390/jcm12196368