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Potential implications of subclinical hypervolemia, identified by a multiparametric approach, in causing left

Marco Allinovi1,2, Valentina Querin3, Silvia Menale4

  • 1Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Florence, Italy. marco.allinovi@gmail.com.

Pediatric Nephrology (Berlin, Germany)
|January 30, 2026
PubMed

Insights

Subclinical hypervolemia in children on dialysis, identified using lung ultrasound (LUS), bioimpedance spectroscopy (BIS), and inferior vena cava collapsibility index (IVC-CI), is linked to left ventricular hypertrophy (LVH). This multiparametric approach aids in early detection and risk assessment for cardiac complications.

Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Physiology
  • Diagnostic Imaging

Background:

  • Fluid overload in pediatric dialysis patients can cause serious cardiac issues like left ventricular hypertrophy (LVH) and dysfunction.
  • Persistent subclinical hypervolemia, appearing as euvolemia clinically but hypervolemia technically, lacks thorough investigation for its cardiovascular impact.
  • This pilot study addresses the gap by exploring methods to detect subclinical hypervolemia and its cardiac effects in children undergoing dialysis.

Purpose of the Study:

  • To evaluate the combined utility of lung ultrasound (LUS), bioimpedance spectroscopy (BIS), and inferior vena cava collapsibility index (IVC-CI) in identifying subclinical hypervolemia in children on chronic dialysis.
  • To investigate the association between subclinical hypervolemia and cardiac complications, specifically left ventricular hypertrophy (LVH).

Main Methods:

  • A longitudinal study involving 23 children on chronic dialysis.
  • Regular fluid status assessments every 2 months using physical examination, LUS, IVC-CI, and BIS.
  • Echocardiography performed every 6 months to assess cardiac parameters.

Main Results:

  • Significant correlations were found between interdialytic weight gain and LUS B-lines (R=0.2923, p<0.001) and BIS OH/ECW (R=0.4144, p<0.001) in clinically euvolemic patients.
  • A negative correlation was observed between interdialytic weight gain and IVC-CI (R=-0.2597, p=0.019).
  • Subclinical hypervolemia was associated with a higher incidence of hypertensive crises (67% vs. 0%, p<0.01) and LVH (75% vs. 27%, p=0.04).

Conclusions:

  • The multiparametric approach combining LUS, BIS, and IVC-CI effectively quantifies subclinical hypervolemia in clinically euvolemic children on dialysis.
  • Subclinical hypervolemia identified through this method is significantly correlated with an increased risk of developing left ventricular hypertrophy (LVH).
Abstract

Keywords:
Chronic dialysisFluid overloadLeft ventricular hypertrophySubclinical hypervolemia

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