{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T22:44:51Z","timestamp":1793054691028,"version":"4.5.0"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":40,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Nephrol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fluid removal during hemodialysis plays a vital role in achieving optimal patient outcomes. Traditional methods to guide dialysis prescription by estimating dry weight are often sufficient, however, lack precision when assessing the nuanced interplay of venous and arterial physiology in hemodynamically complex patients. Left ventricular outflow tract velocity\u2013time integral (LVOT VTI) provides a dynamic marker of forward stroke volume and can offer additional insight into intravascular volume status when conventional ultrasound markers of congestion are limited. LVOT VTI reflects effective left ventricular forward flow and is sensitive to changes in preload. LVOT VTI may improve with judicious fluid removal despite intradialytic hypotension, offering a practical physiological target to guide ultrafiltration in patients with challenging hemodynamics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We present a 70-year-old gentleman with end-stage renal disease (ESRD) who switched to hemodialysis in September 2021 from peritoneal dialysis (PD) due to poor ultrafiltration, resulting in persistent fluid overload, including recurrent pleural effusions. An echocardiogram performed in October 2019 revealed significant pulmonary hypertension, severe tricuspid regurgitation (TR), and moderate mitral regurgitation (MR). Fluid management during hemodialysis proved challenging due to persistent predialysis hypotension and further drops in blood pressure during dialysis sessions. To address these challenges and guide fluid removal more precisely, we utilised point-of-care ultrasound (POCUS) to monitor the patient\u2019s volume status. By prioritising stroke volume surrogates, specifically velocity-time integrals (LVOT VTI), over blood pressure as a guide for fluid removal, we were able to safely increase fluid removal per session and reduce his dry weight by 4 kg over 4 weeks. This was accompanied by significant improvement in his symptoms from fluid overload.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Fluid removal was guided by POCUS to address the patient\u2019s complex hemodynamics. Despite intradialytic hypotension, we observed a significant increase in the patient\u2019s LVOT VTI with ongoing fluid removal. This metric may serve as an adjunctive tool to guide dialysis prescription for select cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12882-026-04870-9","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T16:55:10Z","timestamp":1773334510000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["POCUS-guided fluid removal on haemodialysis using LVOT VTI in a patient with complex hemodynamics, case report"],"prefix":"10.1186","volume":"27","author":[{"given":"Vandse","family":"Aithal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"O\u2019Sullivan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Prager","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"4870_CR1","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s13089-020-00163-w","volume":"12","author":"W Beaubien-Souligny","year":"2020","unstructured":"Beaubien-Souligny W, Rola P, Haycock K, et al. Quantifying systemic congestion with point-of-care ultrasound: development of the venous excess ultrasound grading system. Crit Ultrasound J. 2020;12:16.","journal-title":"Crit Ultrasound J"},{"issue":"1","key":"4870_CR2","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/s13089-024-00370-9","volume":"16","author":"A Wong","year":"2024","unstructured":"Wong A, Olusanya O, Watchorn J, Bramham K, Hutchings S. Utility of the venous excess ultrasound (VEXUS) score to track dynamic change in volume status in patients undergoing fluid removal during haemodialysis: the ACUVEX study. Ultrasound J. 2024;16(1):23.","journal-title":"Ultrasound J"},{"issue":"12","key":"4870_CR3","doi-asserted-by":"publisher","first-page":"2990","DOI":"10.3390\/diagnostics12122990","volume":"12","author":"M Allinovi","year":"2022","unstructured":"Allinovi M, Palazzini G, Lugli G, et al. Pre-dialysis B-line quantification at lung ultrasound for evaluating dry weight and predicting intradialytic hypotension. Diagnostics. 2022;12(12):2990.","journal-title":"Diagnostics"},{"issue":"7","key":"4870_CR4","first-page":"570","volume":"13","author":"SM Alday-Ram\u00edrez","year":"2024","unstructured":"Alday-Ram\u00edrez SM, Leal-Villarreal MAJ, G\u00f3mez-Rodr\u00edguez C, et al. Portal vein Doppler tracks volume status in patients with severe tricuspid regurgitation: a proof-of-concept study. Eur Heart J Acute Cardiovasc Care. 2024;13(7):570\u20134.","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"issue":"9","key":"4870_CR5","doi-asserted-by":"publisher","first-page":"e014308","DOI":"10.1161\/CIRCIMAGING.122.014308","volume":"15","author":"AC Egbe","year":"2022","unstructured":"Egbe AC, et al. Role of inferior vena cava dynamics for estimating right atrial pressure in congenital heart disease. Circ Cardiovasc Imaging. 2022;15(9):e014308.","journal-title":"Circ Cardiovasc Imaging"},{"issue":"6","key":"4870_CR6","doi-asserted-by":"publisher","first-page":"1174","DOI":"10.1213\/ANE.0000000000006820","volume":"138","author":"AC Lipszyc","year":"2024","unstructured":"Lipszyc AC, Walker SCD, Beech AP, Wilding H, Akhlaghi H. Predicting fluid responsiveness using carotid ultrasound in mechanically ventilated patients: a systematic review and meta-analysis. Anesth Analg. 2024;138(6):1174\u201386.","journal-title":"Anesth Analg"},{"issue":"5","key":"4870_CR7","doi-asserted-by":"publisher","first-page":"1319","DOI":"10.1002\/jum.14812","volume":"38","author":"R Bou Chebl","year":"2019","unstructured":"Bou Chebl R, Wuhantu J, Kiblawi S, Carnell J. Bedside echocardiography and passive leg raise as a measure of volume responsiveness in the emergency department. J Ultrasound Med. 2019;38(5):1319\u201326.","journal-title":"J Ultrasound Med"},{"issue":"12","key":"4870_CR8","doi-asserted-by":"publisher","first-page":"1474","DOI":"10.1093\/cvr\/cvx160","volume":"113","author":"R Naeije","year":"2017","unstructured":"Naeije R, Badagliacca R. The overloaded right heart and ventricular interdependence. Cardiovasc Res. 2017;113(12):1474\u201385.","journal-title":"Cardiovasc Res"},{"issue":"1","key":"4870_CR9","doi-asserted-by":"publisher","first-page":"21","DOI":"10.2174\/1570161118666200401112106","volume":"19","author":"A Roumeliotis","year":"2021","unstructured":"Roumeliotis A, et al. Cardiovascular benefits of extended time nocturnal haemodialysis. Curr Vasc Pharmacol. 2021;19(1):21\u201333.","journal-title":"Curr Vasc Pharmacol"}],"container-title":["BMC Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12882-026-04870-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12882-026-04870-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12882-026-04870-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:47:42Z","timestamp":1781639262000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12882-026-04870-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,12]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4870"],"URL":"https:\/\/doi.org\/10.1186\/s12882-026-04870-9","relation":{},"ISSN":["1471-2369"],"issn-type":[{"value":"1471-2369","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,12]]},"assertion":[{"value":"23 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Patient gave written informed consent for clinical details with images to be published.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"251"}}