Bedside IJV Ultrasound Shows Potential for Assessing Fluid Status in Maintenance Haemodialysis: Study
A hypothesis-generating pilot study found that bedside internal jugular vein (IJV) ultrasound was feasible, with several IJV parameters showing exploratory associations with fluid status in maintenance haemodialysis. However, the findings do not establish definitive diagnostic thresholds or support routine clinical use. Larger prospective studies and external validation are needed to confirm its diagnostic utility. The study was published in the journal BMC Nephrology by Alessandro T. and colleagues.
To examine the utility of bedside venous imaging, a study included 49 patients suffering from stage 5 CKD on maintenance haemodialysis. Patients with a history of jugular vein thrombosis, patient’s incapable of performing the procedure, and patients undergoing haemodialysis without ultrafiltration were excluded. Prior to and after one haemodialysis session, each patient underwent a standardized PoCUS imaging of their IJV, and 36 specific sonographic parameters were measured.
Statistical analysis explored correlation between pre-haemodialysis sonographic parameters and the degree of fluid overload (measured as delta of target dry weight), and identified the potential technical confounders and changes in sonographic parameters between pre- and post-haemodialysis using false discovery rate correction.
Key findings:
- Feasibility, pre-dialysis correlations, and post-dialysis volume changes were different for the 49 dialysis patients included in the analysis.
- IJV ultrasound was successfully conducted in 100% of participants (n=49).
- There were no FDR-significant pre-haemodialysis differences or associations in the data obtained by using different clinical or technical modifiers.
- Several pre-haemodialysis ultrasonographic parameters revealed significant exploratory associations with the delta from dry weight after FDR adjustment.
- The following candidate parameters were the most reliable ones: anteroposterior diameter (AP), mediolateral diameter (LL), and cross-sectional area (CSA) at inspiration, jugular vein distensibility ratio (JVD Ratio), and CSA Ratio.
- Paired analysis confirmed high physiological sensitivity to ultrafiltration.
- Fifteen out of 18 paired ultrasound parameters remained significantly decreased post-haemodialysis in comparison with pre-haemodialysis after FDR adjustment.
In summary, the preliminary observational results have shown that ultrasound of the internal jugular vein at the point of care is a feasible bedside evaluation method, which monitors the fluid removal by ultrafiltration in maintenance haemodialysis patients. The results of the study clearly state that the parameters of inspiration and ratio are associated with volume overload.
Reference:
Tomassetti, A., Vetrano, D., Parenti, N. et al. Internal jugular vein ultrasound for fluid status assessment in maintenance haemodialysis: a prospective hypothesis-generating pilot study. BMC Nephrol (2026). https://doi.org/10.1186/s12882-026-05447-2
