Is Inferior vena cava diameter, a reliable indicator for fluid status in end-stage renal disease patients? - A prospective observational study

Abstract

Introduction: Adequate allograft perfusion is the key component of renal-transplant surgeries. This requires meticulous management of volume status in end-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD). Various methods have been tried to unveil the most dependable parameter. So far, central venous pressure (CVP) has been a reliable parameter for guiding fluid therapy. Recently, in the past decade, inferior vena cava (IVC) diameter (IVCD) has emerged as a promising indicator for volume assessment in critically ill patients. However, very limited data are available regarding use of IVC diameter in ESRD patients. This study is an attempt to determine the efficacy of IVC diameter in predicting the volume status of renal-transplant recipients by comparing it with conventional method, CVP. Methods: Enrolling 60 live donor renal-transplant recipients from a single center, the mean IVCD and IVC collapsibility index (IVC-CI) were measured and compared with CVP. IVC measurements were recorded using bedside ultrasonography. CVP was measured using central venous catheter placed in superior vena cava, through a water column on a standardized scale. The data were analyzed using SPSS Version 20. Results: The mean age of the participants was 38.92 ± 10.46 years. The mean CVP was 6.78 ± 2.86 cmH2O, the mean IVCD was 1.30 ± 0.43 cm, the mean IVC-CI was 24.27% ± 15.45%. Based on Pearson's correlation test, there was no linear correlation between CVP and IVCD as well as CVP and IVC-CI. Conclusion: For the assessment of fluid status and fluid responsiveness in ESRD patients with MHD, ultrasound assessment of IVCD and IVC-CI is not routinely helpful.

Keywords

• caval index
• central venous pressure
• inferior vena cava
• ultrasound
• volume status