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

Chronic kidney disease (CKD) affects nearly 850 million people worldwide, and most patients with kidney failure are treated with kidney replacement therapy. Despite technological progress, venous congestion remains a major determinant of morbidity and mortality, and is often underdetected by conventional tools such as clinical evaluation, weight changes, blood pressure measurement, or bioimpedance. Point-of-care ultrasonography (PoCUS) has transformed this diagnostic landscape by providing real-time, physiology-based insights into both left- and right-sided filling pressures. In dialysis care, multiple or confluent B-lines and subtle pleural irregularities suggest elevated pulmonary capillary wedge pressure, while a dilated inferior vena cava (IVC) with reduced collapsibility and increased portal vein pulsatility indicate elevated right atrial pressures. Integrating these sonographic findings into a multiparametric assessment that also includes clinical assessment, bioimpedance, and biosensor feedback enhances diagnostic sensitivity and refines fluid management. Advanced practice nurses (APNs) trained in PoCUS can perform focused examinations of the lungs, IVC, portal venous system, arteriovenous access, and skeletal muscle, translating ultrasound findings into physiological interpretations that guide individualized ultrafiltration strategies and patient care. Nutritional ultrasound (NUS) further complements congestion assessment by quantifying muscle mass and quality, linking nutritional reserve and functional status with hemodynamic tolerance. The implementation of structured education, competency-based training, and standardized scanning protocols allows nurses to incorporate these techniques safely and reproducibly into daily dialysis workflows. By integrating PoCUS and NUS within interdisciplinary decision-making, nursing practice evolves from procedural to diagnostic, supporting early identification of congestion, protection of vascular access, and detection of malnutrition. This multiparametric, physiology-guided approach exemplifies the concept of precision nursing, where patient evaluation becomes continuous, individualized, and grounded in real-time pathophysiological insight.