Point-of-Care Ultrasonography in Advanced Nephrology Nursing Practice: Seeing Beyond the Numbers.

Area of Science:

• Nephrology
• Cardiology
• Nursing Science

Background:

• Chronic kidney disease (CKD) impacts 850 million globally, with kidney failure often requiring replacement therapy.
• Venous congestion is a key factor in morbidity and mortality, frequently missed by traditional assessment tools.
• Point-of-care ultrasonography (PoCUS) offers real-time, physiology-based evaluation of filling pressures, improving diagnostic capabilities.

Purpose of the Study:

• To explore the integration of PoCUS and Nutritional Ultrasound (NUS) into nursing practice for managing CKD patients.
• To enhance the early detection of venous congestion and malnutrition in dialysis patients.
• To demonstrate how PoCUS and NUS enable precision nursing through individualized, physiology-guided care.

Main Methods:

• Utilizing PoCUS to assess lung B-lines, pleural irregularities, inferior vena cava (IVC) diameter and collapsibility, and portal vein pulsatility.
• Integrating sonographic findings with clinical assessment, bioimpedance, and biosensor feedback for multiparametric evaluation.
• Employing NUS to quantify muscle mass and quality, linking nutritional status to hemodynamic tolerance.

Main Results:

• PoCUS identifies elevated pulmonary capillary wedge pressure and right atrial pressures, crucial indicators of congestion.
• Advanced practice nurses (APNs) trained in PoCUS can perform focused examinations guiding fluid management and ultrafiltration.
• NUS assessment complements congestion evaluation by assessing nutritional reserve and functional status.

Conclusions:

• Integrating PoCUS and NUS transforms nursing practice towards a diagnostic role, improving patient care in CKD.
• This multiparametric, physiology-guided approach supports early congestion identification, vascular access protection, and malnutrition detection.
• Precision nursing, grounded in real-time pathophysiological insight, enables continuous, individualized patient evaluation and management.