Tracking Volume Changes with VEXUS Ultrasound During Hemodialysis: The ACUVEX Study

Ultrasound-based tools, including the Venous Excess Ultrasound (VEXUS) score, are increasingly used in fluid status assessment, particularly in clinical settings like hemodialysis. This single-center observational study evaluated the VEXUS score’s ability to track dynamic fluid changes during dialysis in patients with end-stage renal failure (ESRF) presenting above their target dry weight. Conducted in a London tertiary care hospital from May to October 2022, the study involved 33 adult patients requiring fluid removal of at least 2 liters. Ultrasound assessments, including cardiac and lung evaluations, were performed before, during, and after dialysis using a Philips Affiniti Ultrasound System. VEXUS scoring was based on Doppler measures, with venous congestion assessed via the inferior vena cava diameter, hepatic venous flow patterns, and other parameters. Patients with elevated VEXUS scores (>0) demonstrated significant reductions in venous congestion during dialysis, indicating its utility in tracking fluid removal. These patients also showed evidence of both right and left ventricular systolic dysfunction, suggesting that elevated VEXUS scores may reflect cardiac failure rather than venous volume overload alone. Lung ultrasound scores and echocardiographic findings further complemented the assessment of fluid dynamics and cardiac function. While the study observed a low incidence of venous congestion overall, it highlighted the VEXUS score’s potential to monitor changes in fluid status and guide dialysis management. Ethical approval was obtained from the South Central-Berkshire Research and Ethics Committee, and all patients provided informed consent. These findings underscore the VEXUS score’s relevance in dialysis settings, emphasizing its role in optimizing fluid balance and improving patient outcomes. Future studies could further explore its applicability in broader clinical contexts.