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논문분류	춘계학술대회 초록집
제목	Diagnosis of Volume Insufficiency Presenting as Painful Arteriovenous Fistula During Hemodialysis by Point-of-Care Ultrasound
저자	EunJung Kim
출판정보	2024; 2024(1):
키워드
초록	An 85-year-old male patient diagnosed with diabetic end-stage kidney disease commenced hemodialysis via a newly created left brachio-cephalic arteriovenous fistula (AVF). He persistently complained of vascular pain at the AVF within 1-2 hours of initiating each hemodialysis session. The pain was so severe that hemodialysis treatment had to be halted but subsided after discontinuation of the session. Subsequently, a vascular access ultrasound was conducted, revealing a brachial artery blood flow rate of 1800 ml/min and no additional abnormal features in the arteriovenous fistula (Figure 1). We performed a Point-of-Care Ultrasound (POCUS) just before a hemodialysis session, including lung ultrasound and venous excess Doppler ultrasound (VExUS), to assess blood volume status. Lung ultrasound findings from eight zones presented only A-lines without abnormal B-lines (Figure 2A). The inferior vena cava (IVC) diameter was less than 2.0 cm with a collapsibility index was over 50% with respiratory variation (Figure 2B). The pulsed wave Doppler waveforms of the portal vein remained continuous monophasic waveforms (Figure 2C). The hepatic vein waveforms exhibited normal S and D components (Figure 2D). Based on the normal findings of the lung ultrasound and VExUS, we decided to increase the patient's dry weight and limit ultrafiltration during HD. Following the POCUS examination, adjusting the dry weight from 56.5 kg to 59.5 kg resulted in the complete resolution of vascular pain without any signs or symptoms of volume overload. This case underscores the critical role of POCUS in the real-time diagnosis of ischemia-related vascular pain due to volume insufficiency in hemodialysis patients. It also demonstrates how POCUS-guided volume assessment can assist in accurately establishing dry weight and managing ultrafiltration, thereby preventing ischemic complications and improving patient outcomes.
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