Utility of the inferior vena cava diameter as a marker of dry weight in nonoliguric hemodialyzed patients.

Abstract

We have previously reported that the maximal inferior vena cava (IVC) diameter during quiet expiration (IVCe) measured by ultrasonography correlates well with the amount of body fluid, especially the circulating blood volume(2) and proposed using the criteria of IVC diameter to determine dry weight (DW) in anuric hemodialyzed (HD) patients: standard IVCe of pre- and post-HD are 14.9 +/- 0.4 and 8.2 +/- 0.3 mm, respectively (1). However, the same post-HD IVC criterion should not be applied to nonoliguric HD patients because it could result in rapid deterioration of residual renal function due to forced dehydration. Although the biochemical DW marker plasma atrial natriuretic peptide (ANP) is useful to evaluate hypervolemia but not hypovolemia, both hyper- and hypovolemia can be detected by IVC measurement. In the present study, we investigated whether the IVC diameter serves as an optimal evaluation of DW in nonoliguric HD (NO-HD) patients, avoiding not only overhydration but also dehydration. The IVCe and plasma ANP levels were measured in 14 euvolemic patients with chronic renal failure at conservative period (CP-CRF) and 11 NO-HD patients, in whom the average daily urine volume was more than 500 ml/day. In NO-HD patients, DW was adjusted to attain the euvolemic state with normotensive blood pressure, lack of edema, and lack of temporal oliguria after HD. The ANP in CP-CRF patients was 109.3 +/- 15.3 pg/ml, and pre- and post-HD ANP levels in NO-HD patients were 145.3 +/- 23.5 and 97.5 +/- 13.5 pg/ml, respectively. IVCe in CP-CRF was 13.4 +/- 0.9 mm, and pre- and post-HD IVCe in NO-HD patients were 14.2 +/- 1.0 mm and 11.9 +/- 0.9 mm, respectively. Although the post-HD IVCe was greater (i.e., less hypovolemic) than that in anuric HD patients, and close to the IVCe in CP-CRF, pre-HD IVCe was comparable with that in anuric HD patients. In addition, the pre-HD ANP level was no higher than that in CP-CRF. Thus, in NO-HD patients, the post-IVCe of 11.9 +/- 0.9 mm would be a marker for an appropriate DW setting avoiding severe post-HD dehydration as well as excessive hypervolemia during the interdialytic period.