{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:50:23Z","timestamp":1791521423458,"version":"4.3.4"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nephrol."],"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>Accurate volume assessment in maintenance hemodialysis remains challenging because no single bedside method fully characterizes extracellular fluid overload. We evaluated discordance among clinical examination, bioimpedance spectroscopy, and abbreviated six-zone lung ultrasound, the prevalence of subclinical pulmonary congestion, and factors associated with pulmonary congestion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-center cross-sectional study, 116 adults receiving maintenance hemodialysis without clinically recognized heart failure underwent standardized clinical examination, whole-body bioimpedance spectroscopy, and predialysis six-zone lung ultrasound. Subclinical pulmonary congestion was defined as a prespecified total B-line count of \u22653 in clinically euvolemic patients. Agreement was assessed using Cohen\u2019s kappa, and independent associations were evaluated using multivariable Poisson regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 49 clinically euvolemic patients, 27 (55.1%) had subclinical pulmonary congestion, representing 23.3% of the cohort. Clinical examination showed fair agreement with lung ultrasound for \u22653 B-lines (\u03ba = 0.28; 95% CI, 0.11\u20130.45), whereas agreement between lung ultrasound and bioimpedance-defined overhydration was slight (\u03ba = 0.16; 95% CI, \u22120.03 to 0.35). Bioimpedance-derived overhydration, but not interdialytic weight gain, was independently associated with subclinical pulmonary congestion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Discordance among clinical examination, bioimpedance spectroscopy, and lung ultrasound was common and is consistent with the hypothesis that these modalities capture partially distinct aspects of volume status and pulmonary congestion. Abbreviated lung ultrasound frequently identified clinically occult pulmonary congestion despite apparent clinical euvolemia, supporting a multidimensional approach to bedside volume assessment in maintenance hemodialysis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneph.2026.2000700","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:25:58Z","timestamp":1791519958000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Physiological discordance between clinical examination, bioimpedance spectroscopy, and lung ultrasound in maintenance hemodialysis patients without heart failure"],"prefix":"10.3389","volume":"6","author":[{"given":"Irwing R.","family":"Benites-Flores","sequence":"first","affiliation":[{"name":"Department of Nephrology, Hospital Alberto Barton Thompson","place":["Callao, Peru"]},{"name":"Department of Nephrology, Hospital Edgardo Rebagliati Martins","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Rodr\u00edguez Revilla","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Alberto Barton Thompson","place":["Callao, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Taype-Rondan","sequence":"additional","affiliation":[{"name":"Unidad de Investigaci\u00f3n para la Generaci\u00f3n y S\u00edntesis de Evidencias en Salud, Vicerrectorado de Investigaci\u00f3n, Universidad San Ignacio de Loyola","place":["Lima, Peru"]},{"name":"EVITA Research Center, EviSalud \u2013 Evidencias en Salud","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana C.","family":"Fern\u00e1ndez-Anticona","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Alberto Barton Thompson","place":["Callao, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Augusto","family":"Prado Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Alberto Barton Thompson","place":["Callao, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelly","family":"Seminario Alegre","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Edgardo Rebagliati Martins","place":["Lima, Peru"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celia","family":"Rodr\u00edguez Tudero","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Universitario de Salamanca","place":["Salamanca, Spain"]},{"name":"Department of Surgery, Faculty of Medicine, University of Salamanca","place":["Salamanca, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esperanza","family":"Moral Berrio","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital General Universitario de Ciudad Real","place":["Ciudad Real, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Jimenez Mayor","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Santa B\u00e1rbara","place":["Soria, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avinash","family":"Chandu Nanwani","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital General de Fuerteventura","place":["Fuerteventura, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 C.","family":"De la Flor","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hospital Central de la Defensa G\u00f3mez Ulla","place":["Madrid, Spain"]},{"name":"Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcal\u00e1","place":["Madrid, 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