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Point-of-care ultrasound in end-stage kidney disease: beyond lung ultrasound

Beaubien-Souligny, Williama,b; Bouchard, Joséec; Denault, Andréb,d

Current Opinion in Nephrology and Hypertension: November 2018 - Volume 27 - Issue 6 - p 487–496
doi: 10.1097/MNH.0000000000000453
DIALYSIS AND TRANSPLANTATION: Edited by J. Kevin Tucker and Anil Chandraker

Purpose of review Following the miniaturization of ultrasound devices, point-of-care ultrasound (POCUS) has been proposed as a tool to enhance the value of physical examination in various clinical settings. The objective of this review is to describe the potential applications of POCUS in end-stage renal disease patients (ESRD).

Recent findings With basic training, the clinician can perform pulmonary, vascular, cardiac, and abdominal POCUS at the bedside of ESRD patients. Pulmonary ultrasound can be used to quantify pulmonary congestion and for the differential diagnosis of dyspnea. Ultrasound of the inferior vena cava combined with simple cardiac ultrasound can be used to promptly investigate the mechanism of hemodynamic instability. Vascular ultrasound can be used for troubleshooting of arteriovenous fistula problems and for catheter installation. Multiple potential applications of POCUS in the ESRD population are reviewed, including areas of future research.

Summary Acquiring basic skills in POCUS may improve patient care through the rapid identification of threats, improved diagnostic abilities for common symptoms, and safer procedures. The adoption of POCUS in undergraduate, internal medicine and nephrology training curriculums will likely lead to a gradual introduction of this technology in the care of ESRD patients.

aDivision of Nephrology, Centre Hospitalier de l’Université de Montréal

bDepartment of Anesthesiology and Intensive Care, Montreal Heart Institute

cDivision of Nephrology, Hôpital Sacré-Coeur de Montreal,

dDivision of Intensive Care, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada

Correspondence to André Denault, MD, PhD, Montreal Heart Institute, 5000 Belanger St., Montreal, Quebec H1T 1C8, Canada. Tel: +1 514 376 3330; fax: +1 514 376 1355; e-mail: andre.denault@umontreal.ca

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