{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T23:20:39Z","timestamp":1778541639864,"version":"3.51.4"},"reference-count":56,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T00:00:00Z","timestamp":1765670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Chronic kidney disease (CKD) affects nearly 850 million people worldwide, and most patients with kidney failure are treated with kidney replacement therapy. Despite technological progress, venous congestion remains a major determinant of morbidity and mortality, and is often underdetected by conventional tools such as clinical evaluation, weight changes, blood pressure measurement, or bioimpedance. Point-of-care ultrasonography (PoCUS) has transformed this diagnostic landscape by providing real-time, physiology-based insights into both left- and right-sided filling pressures. In dialysis care, multiple or confluent B-lines and subtle pleural irregularities suggest elevated pulmonary capillary wedge pressure, while a dilated inferior vena cava (IVC) with reduced collapsibility and increased portal vein pulsatility indicate elevated right atrial pressures. Integrating these sonographic findings into a multiparametric assessment that also includes clinical assessment, bioimpedance, and biosensor feedback enhances diagnostic sensitivity and refines fluid management. Advanced practice nurses (APNs) trained in PoCUS can perform focused examinations of the lungs, IVC, portal venous system, arteriovenous access, and skeletal muscle, translating ultrasound findings into physiological interpretations that guide individualized ultrafiltration strategies and patient care. Nutritional ultrasound (NUS) further complements congestion assessment by quantifying muscle mass and quality, linking nutritional reserve and functional status with hemodynamic tolerance. The implementation of structured education, competency-based training, and standardized scanning protocols allows nurses to incorporate these techniques safely and reproducibly into daily dialysis workflows. By integrating PoCUS and NUS within interdisciplinary decision-making, nursing practice evolves from procedural to diagnostic, supporting early identification of congestion, protection of vascular access, and detection of malnutrition. This multiparametric, physiology-guided approach exemplifies the concept of precision nursing, where patient evaluation becomes continuous, individualized, and grounded in real-time pathophysiological insight.<\/jats:p>","DOI":"10.3390\/diagnostics15243196","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T10:11:23Z","timestamp":1765793483000},"page":"3196","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Point-of-Care Ultrasonography in Advanced Nephrology Nursing Practice: Seeing Beyond the Numbers"],"prefix":"10.3390","volume":"15","author":[{"given":"Antoni","family":"Garcia-Lahosa","sequence":"first","affiliation":[{"name":"Nursing Team, Nephrology Department, University Hospital Germans Trias I Pujol, Carretera de Canyet s\/n, 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergio","family":"Moreno-Mill\u00e1n","sequence":"additional","affiliation":[{"name":"Nursing Team, Nephrology Department, University Hospital Germans Trias I Pujol, Carretera de Canyet s\/n, 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Cruz","family":"Sanchez-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Nursing Team, Nephrology Department, University Hospital Germans Trias I Pujol, Carretera de Canyet s\/n, 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel","family":"Sanchez-Cardenas","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Universidad El Bosque, Bogot\u00e1 110131, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christiane","family":"Steiss","sequence":"additional","affiliation":[{"name":"PHV Dialysis Center, University Hospital Giessen and Marburg, 35392 Giessen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8965-0365","authenticated-orcid":false,"given":"Wilmer Jim","family":"Escobar","sequence":"additional","affiliation":[{"name":"Asociaci\u00f3n Vascular de Enfermer\u00eda de Per\u00fa (AVEDPERU), 153116 Lima, Peru"},{"name":"Latin American Association of Nephrology Nursing (ALAEN), Montevideo 11300, Uruguay"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel","family":"Nu\u00f1ez-Moral","sequence":"additional","affiliation":[{"name":"Peritoneal Dialysis Unit, University Hospital Central of Asturias (HUCA), 33011 Oviedo, Spain"},{"name":"Faculty of Nursing, University of Oviedo, 33003 Oviedo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordi","family":"Soler-Majoral","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias I Pujol, 08916 Badalona, Spain"},{"name":"REMAR-IGTP Group, Germans Trias i Pujol Research Institute, Can Ruti Campus, 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredzzia","family":"Graterol Torres","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias I Pujol, 08916 Badalona, Spain"},{"name":"REMAR-IGTP Group, Germans Trias i Pujol Research Institute, Can Ruti Campus, 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordi","family":"Ara","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias I Pujol, 08916 Badalona, Spain"},{"name":"REMAR-IGTP Group, Germans Trias i Pujol Research Institute, Can Ruti Campus, 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3577-2273","authenticated-orcid":false,"given":"Jordi","family":"Bover","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias I Pujol, 08916 Badalona, Spain"},{"name":"REMAR-IGTP Group, Germans Trias i Pujol Research Institute, Can Ruti Campus, 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Emilio","family":"S\u00e1nchez-Alvarez","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Central of Asturias (HUCA), 33011 Oviedo, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6742-5052","authenticated-orcid":false,"given":"Faeq","family":"Husain-Syed","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, 35392 Giessen, Germany"},{"name":"International Renal Research Institute of Vicenza, 36100 Vicenza, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5801-3574","authenticated-orcid":false,"given":"Abhilash","family":"Koratala","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7481-3678","authenticated-orcid":false,"given":"Gregorio","family":"Romero-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias I Pujol, 08916 Badalona, Spain"},{"name":"REMAR-IGTP Group, Germans Trias i Pujol Research Institute, Can Ruti Campus, 08916 Badalona, Spain"},{"name":"International Renal Research Institute of Vicenza, 36100 Vicenza, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia","family":"Fern\u00e1ndez-Delgado","sequence":"additional","affiliation":[{"name":"Hemodialysis and Home Therapies Unit, University Hospital Germans Trias I Pujol, 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5855-8494","authenticated-orcid":false,"given":"Nestor","family":"Rodr\u00edguez-Chitiva","sequence":"additional","affiliation":[{"name":"Nephrology Department, University Hospital Germans Trias I Pujol, 08916 Badalona, Spain"},{"name":"REMAR-IGTP Group, Germans Trias i Pujol Research Institute, Can Ruti Campus, 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth","family":"Marcos-Ballesteros","sequence":"additional","affiliation":[{"name":"Nursing Team, Nephrology Department, University Hospital Germans Trias I Pujol, Carretera de Canyet s\/n, 08916 Badalona, Spain"},{"name":"Hemodialysis and Home Therapies Unit, University Hospital Germans Trias I Pujol, 08916 Badalona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/S0140-6736(20)30045-3","article-title":"Global, regional, and national burden of chronic kidney disease, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"395","author":"Bikbov","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1093\/ndt\/gfaf068","article-title":"Maintaining kidney health in aging societies: A JSN and ERA call to action","volume":"40","author":"Ortiz","year":"2025","journal-title":"Nephrol. 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