Target weight optimization based on a modified VExUS protocol in hemodialysis: the VexHD prospective multi-center...

Clinical examination has limitations in estimating fluid overload in hemodialysis patients. The aim of the present study is to evaluate the impact of target weight optimization using a modified Venous Excess Ultrasonography Score (VExUS) protocol on blood pressure control in euvolemic hemodialysis patients.

We enrolled clinically euvolemic patients in hemodialysis from ten Spanish centers. Baseline clinical data, bioimpedance, and an extensive panel of cardiac, congestion, and inflammatory biomarkers were collected. Patients with congestion on modified VExUS protocol (excluding intrarenal vessels) underwent protocol‑driven ultrafiltration adjustments. Blood pressure, bioimpedance, and biomarkers were reassessed at study completion, and paired statistical analyses were performed.

Among the 72 clinically euvolemic patients included (60% male, mean age 69±18 years), 23 (32%) showed venous congestion on modified VExUS protocol and entered the intervention group and 49 were followed under routine care conditions (reference). Volume values obtained by bioimpedance spectroscopy were similar in the congestion intervention and non-congestion reference groups. After four weeks, the intervention group experienced a significant improvement in modified VExUS protocol parameters compared to baseline (2.1±0.5 vs 1.3±0.5; p<0.001) and a systolic blood pressure reduction compared with reference group participants (-14 [-37;4] vs 4 [-9;14] mmHg) (p=0.025). The reduction in systolic blood pressure was more notable in patients with higher baseline values. There were no differences in hemodialysis tolerance or biomarker changes between intervention and reference group participants.

Modified VExUS protocol is a promising tool for evaluating volume overload and optimizing target weight. Its incorporation in the multiparametric assessment of target weight is associated with better blood pressure control.