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

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 I...

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Published in:	Nephron extra Vol. 4; no. 1; pp. 82 - 88
Main Authors:	Muniz Pazeli, José, Fagundes Vidigal, Daniel, Cestari Grossi, Tarcísio, Silva Fernandes, Natália Maria, Colugnati, Fernando, Baumgratz de Paula, Rogério, Sanders-Pinheiro, Hélady
Format:	Journal Article
Language:	English
Published:	Basel, Switzerland S. Karger AG 30-04-2014
Subjects:	Original Paper Point-of-care ultrasonography Agreement Fluid status Hemodialysis Inferior vena cava
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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.
AbstractList	BACKGROUND/AIMSThe 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. METHODSA 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. RESULTSThe 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. CONCLUSIONSUltrasound evaluation of the IVC can be performed by nephrologists using an RUS to assess the volemic status in hemodialysis patients. 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. 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. 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. Ultrasound evaluation of the IVC can be performed by nephrologists using an RUS to assess the volemic status in hemodialysis patients. 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.
Author	Cestari Grossi, Tarcísio Silva Fernandes, Natália Maria Sanders-Pinheiro, Hélady Muniz Pazeli, José Fagundes Vidigal, Daniel Baumgratz de Paula, Rogério Colugnati, Fernando
AuthorAffiliation	b Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Barbacena, Brazil c Clinical Department, Faculty of Medicine of Barbacena (FAME), Barbacena, Brazil a Division of Nephrology, Federal University of Juiz de Fora, Barbacena, Brazil d Pró-Renal Center of Renal Diseases and Dialysis Unit, Barbacena, Brazil e World Interactive Network Focused on Critical Ultrasound (WINFOCUS), Milan, Italy
AuthorAffiliation_xml	– name: d Pró-Renal Center of Renal Diseases and Dialysis Unit, Barbacena, Brazil – name: b Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia (NIEPEN), Juiz de Fora, Barbacena, Brazil – name: c Clinical Department, Faculty of Medicine of Barbacena (FAME), Barbacena, Brazil – name: e World Interactive Network Focused on Critical Ultrasound (WINFOCUS), Milan, Italy – name: a Division of Nephrology, Federal University of Juiz de Fora, Barbacena, Brazil
Author_xml	– sequence: 1 givenname: José surname: Muniz Pazeli fullname: Muniz Pazeli, José – sequence: 2 givenname: Daniel surname: Fagundes Vidigal fullname: Fagundes Vidigal, Daniel – sequence: 3 givenname: Tarcísio surname: Cestari Grossi fullname: Cestari Grossi, Tarcísio – sequence: 4 givenname: Natália Maria surname: Silva Fernandes fullname: Silva Fernandes, Natália Maria – sequence: 5 givenname: Fernando surname: Colugnati fullname: Colugnati, Fernando – sequence: 6 givenname: Rogério surname: Baumgratz de Paula fullname: Baumgratz de Paula, Rogério – sequence: 7 givenname: Hélady orcidid: 0000-0001-8603-1331 surname: Sanders-Pinheiro fullname: Sanders-Pinheiro, Hélady email: helady.sanders@ufjf.edu.br
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Keywords	Point-of-care ultrasonography Agreement Fluid status Hemodialysis Inferior vena cava
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Snippet	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... 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... BACKGROUND/AIMSThe costs and the need for a specialist impair the implementation of ultrasonography for evaluating the inferior vena cava (IVC) to assess the...
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Title	Can Nephrologists Use Ultrasound to Evaluate the Inferior Vena Cava A Cross-Sectional Study of the Agreement between a Nephrologist and a Cardiologist
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