Ultrasound-guided haemodynamic profiling in haemodialysis patients: a single-centre prospective observational study
End-stage kidney disease treated with maintenance haemodialysis; intradialytic hypotension and fluid overload/haemodynamic instability during haemodialysis.
This is a single-centre prospective observational cohort study in adult patients receiving maintenance haemodialysis. After written informed consent, participants undergo study assessments during routine dialysis care. At baseline, month 3, month 6 and month 9, a trained operator performs multi-organ point-of-care ultrasound immediately before and after one haemodialysis session. The ultrasound assessment includes focused cardiac ultrasound, lung ultrasound B-line assessment and a modified VEXUS venous congestion assessment using inferior vena cava, hepatic vein and portal vein measurements. Routine haemodialysis proceeds unchanged. No study-mandated therapeutic algorithm is applied, and the study team does not require or recommend changes to the dialysis prescription on the basis of ultrasound findings. Session-level clinical data, intradialytic blood-pressure recordings, symptoms, ultrafiltration data, dialysate prescription and nursing interventions are recorded from routine care and the case report form. When clinically feasible and safe, additional event-triggered ultrasound may be performed during or immediately after intradialytic hypotension, suspected clinically significant fluid overload or suspected underestimated dry weight. For scheduled sessions, the treating physician completes a brief questionnaire before disclosure of the study ultrasound findings and again after delayed disclosure, after the dialysis session has finished and intradialytic outcome data have been recorded, except for prespecified emergency findings. Each participant is followed for 12 months for hospitalisations, cardiovascular events and mortality.
1. Adults aged 18 years or older 2. Receiving thrice-weekly chronic haemodialysis for end-stage kidney disease 3. Receiving haemodialysis treatment at the study centre 4. Able and willing to provide written informed consent
1. Unable safely to undergo ultrasound procedures or follow the protocol, for example because of an open chest wound or severe skin infection at probe sites 2. Cognitive inability to provide informed consent without a legal representative 3. Pregnancy 4. Prisoner status or other vulnerable status preventing freely given consent 5. Peritoneal dialysis 6. If a participant receives a kidney transplant or transfers care during the study, active participation ends from that point; data collected up to that time remain included