Accurate assessment of intravascular volume is vital for managing hospitalized hemodialysis patients, particularly those with end-stage renal disease (ESRD). This study evaluated the Adapted Sonographic Assessment of Fluid Estimate (SAFE-A) protocol in assessing intravascular volume before and after hemodialysis sessions and correlating these findings with net ultrafiltrate (UFNET). Thirty adult patients undergoing regular hemodialysis participated. Sonographic assessments included cardiac contractility, inferior vena cava (IVC) and internal jugular vein (IJV) collapsibility indices, and pulmonary B-lines using a portable ultrasound device. Each parameter was scored to estimate relative intravascular volume and classified patients as hypovolemic, normovolemic, or hypervolemic.
Findings revealed a significant correlation between decreases in SAFE-A scores and UFNET, with a 1-point score reduction corresponding to a withdrawal of 426.73 mL of UFNET. This confirms the reliability of SAFE-A in monitoring intravascular volume changes during hemodialysis. Adjustments in the original SAFE protocol scoring (+1, +2, +3) demonstrated consistency with previous findings, underscoring its applicability across diverse patient populations. By incorporating dynamic ultrasound parameters like IVC collapsibility and pulmonary B-line counts, SAFE-A provides a comprehensive evaluation of volemic status. This approach enhances precision in managing fluid removal, minimizing risks of intradialytic hypotension, and optimizing patient outcomes.
The study highlights the utility of bedside ultrasonography, even in resource-limited settings, for guiding volume assessment and treatment strategies. The SAFE-A protocol emerges as a valuable tool for improving care quality and individualizing therapy in hemodialysis patients.
