Internal Jugular Vein Ultrasound for Fluid Status Assessment in Maintenance Haemodialysis: A Prospective Pilot Exploratory Study

Internal Jugular Vein Ultrasound for Fluid Status Assessment in Maintenance Haemodialysis: A Prospective Pilot Exploratory Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Internal Jugular Vein Ultrasound for Fluid Status Assessment in Maintenance Haemodialysis: A Prospective Pilot Exploratory Study Alessandro Tomassetti, Daniele Vetrano, Nicola Parenti, Vittorio Dalmastri, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9141317/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Assessment of fluid status in patients receiving maintenance haemodialysis remains challenging. Point-of-care ultrasound (PoCUS) is increasingly used to support bedside evaluation of volume overload. The internal jugular vein (IJV) has been proposed as a potential marker of central venous pressure and systemic congestion. This pilot exploratory study aimed to investigate the feasibility and potential clinical utility of IJV ultrasound in patients undergoing maintenance haemodialysis. We conducted a prospective observational pilot exploratory study including CKD G5D patients undergoing maintenance haemodialysis. Patients with a history of jugular vein thrombosis, those receiving isovolemic dialysis treatments, and those unable to comply with the study protocol were excluded. Immediately before and after a scheduled haemodialysis session, patients underwent PoCUS examination of the internal jugular vein. Thirty-six ultrasonographic parameters were collected and analysed. Correlations between ultrasound parameters and fluid overload (delta from dry weight) were evaluated together with changes between pre- and post-dialysis examinations. Forty-nine patients were enrolled. IJV ultrasound measurements were not significantly influenced by several potential confounders including sex, body size, vascular access type, and the presence of heart failure. Several ultrasonographic parameters were significantly correlated with delta from dry weight. Among these, the Jugular Vein Distension (JVD) ratio showed the strongest association. Multiple parameters demonstrated significant changes between pre- and post-dialysis examinations. In this pilot exploratory study, IJV ultrasound appeared to be a feasible bedside tool for the assessment of fluid status in haemodialysis patients. Larger studies are needed to validate these findings and to determine the clinical utility of IJV-derived indices such as the JVD ratio. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Nephrology Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 BACKGROUND In patients with end-stage renal disease treated with chronic haemodialysis residual renal function is usually insufficient to maintain hydro-saline homeostasis, thus leading to the need of ultrafiltration to avoid volume overload. This treatment is characterized by a narrow therapeutic index, since the slightest under- or overdosage of ultrafiltration could impact on patients’ outcome. Indeed, while chronic sodium overload induces cardiac remodelling resulting in an enhanced CV risk [1-2], even a subclinical ultrafiltration (UF) overdosage causes visceral hypoperfusion that leads to loss of the residual renal function, myocardial stunning and cerebral damage [3-5]. Furthermore, population on maintenance haemodialysis is becoming increasingly complex and frail. Frailty and comorbidities complicate volume status evaluation because of the coexistence of condition such as malnutrition, sarcopenia, chronic heart failure, chronic inflammation. Among the wide array of instruments that physicians can use to improve the precision of the dry weight definition and consequent ultrafiltration prescription, ultrasonography is gaining raising interest due to the well-known winning characteristics of Point-of-Care (PoCUS) examination and the development of techniques that can provide repeatable results [6-10]. Given the physiological characteristics of the venous system, the ultrasonographic evaluation of the inferior vena cava (IVC) is a pillar of the PoCUS evaluation of fluid balance, routinary used by physicians in many branches of the clinical practice. However, IVC ultrasonography reliability is still debated in literature [11-13]. For this reason, many authors studied the internal jugular vein (IJV) ultrasonography as a marker of volume status, mainly in the intensive care and cardiologic settings [14-20]. The IJV has been mainly studied to provide a measure of central venous pressure (CVP), but many studies performed in the cardiologic setting demonstrated that IJV ultrasound could provide further information with clinical relevance (i.e. outcome predictors) which make this exam suitable for the implementation in clinical algorithms for the evaluation of patients with HF [21]. Despite the rapid and easy execution (due to the superficial anatomical location of the IJV) and the interesting evidence that will be further discussed besides our results, only two studies investigated the role of this exam in the setting of chronic haemodialysis. Sekiguchi et al. demonstrated that an elevated CVP could be diagnosed by the evaluation of the internal jugular vein aspect ratio [22]. Kerleroux et al. estimated the CVP of 22 patients by measuring the height of the internal jugular vein collapsing, determined via ultrasonography [23]. The two studies aimed to identify a parametric predictor of the CVP. Consequently, these works suffer from two main limitations: first, authors included only patients receiving haemodialysis via CVC, then, these works provided only a limited amount of data. Therefore, we performed an observational prospective study to investigate which role could play the ultrasonography of the internal jugular vein in the setting of maintenance haemodialysis. STUDY OBJECTIVES Our study aims: To assess whether inferior jugular vein ultrasonography is biased by the laterality of the studied vein (right or left internal jugular vein), the presence of an arteriovenous fistula (AVF) or central venous catheter (CVC), the presence of chronic heart failure, the presence of atrial fibrillation (AF), sex, age, body mass index (BMI) and body surface area (BSA) To find a correlation between the pre dialysis volume overload and the ultrasonographic parameters To describe the variation of ultrasonographic parameters in response to the haemodialytic treatment METHODS We conducted a prospective observational trial performed in the Haemodialysis Centre - Ospedale Maggiore in Bologna, Italy (IT). Ethical considerations All patients were included after written informed consent. The study was approved by The Ethical Committee CE-AVEC, approval number 455-2025-OSS-AUSLBO. The study was carried out according to the Helsinki Declaration. Study design The only inclusion criterion was the CKD G5D receiving regular maintenance haemodialysis in our centre. The exclusion criteria were: Pathological history of Internal Jugular Vein thrombosis, including catheter-related thrombosis Insufficient compliance Routinary prescription of non ultrafiltrative treatments. Patients were enrolled between July, 1 st , 2024 and October, 1 st , 2024. In Fig.1 is summarized the study proceedings. After the enrolment, patients undergo a medical examination before the scheduled dialysis session in which past medical history and interdialytic anamnesis is compiled, physical examination is performed, dry weight is redefined or confirmed. Then, patients undergo a first ultrasonographic examination, as will be further discussed. After the clinical and ultrasonographic evaluation, the haemodialysis session gets started and patients is connected to the extracorporeal circuit. At the end of the treatment, before the disconnection from the extracorporeal circuit, a second ultrasonographic examination is performed and monitoring data are collected. Ultrasonographic Examination All the ultrasonographic examinations were conducted by a single operator, using Mindray M7 or Esaote MyLab X Pro 30 ultrasonographers, convex 1-6 MHz and linear 3-10 MHz probes and factory presets for the evaluation of abdomen and venous vessels. The ultrasonographic evaluations were conducted as follows: Patient in supine decubitus, 45° tilt. The internal right jugular vein is identified with a linear 3-10 MHz probe that gets positioned 2 cm distant from the clavicle in a transverse scan. If the right internal jugular vein was cannulated, left internal jugular vein is evaluated. The following measures are taken in inspirium and resting: anteroposterior and laterolateral diameters (leading edge to leading edge technique); cross section area. Patient is asked to perform a Valsalva maneuver During the Valsalva maneuver the following measures are taken: anteroposterior and laterolateral diameters (leading edge to leading edge technique); cross section area. Ultrasonographic evaluation of the inferior vena cava. Patient in supine decubitus. The inferior vena cava is identified with a convex 1-6 MHz probe that gets positioned in subxyphoid sagittal scan, parallel with the vein sagittal axis. The anteroposterior diameter, sampled 2-3 cm below diaphragm, is measured in inspirium and resting. Ultrasonographic variables We defined the following variables: AP Resting : jugular vein’s anteroposterior diameter resting LL Resting : jugular vein’s laterolateral diameter resting Aspect Resting : AP Resting / LL Resting CSA Resting : jugular vein’s cross section area resting AP Inspirium : jugular vein’s anteroposterior diameter in inspirium LL Inspirium : jugular vein’s laterolateral diameter in inspirium Aspect Inspirium : AP Inspirium / LL Inspirium CSA Inspirium : jugular vein’s cross section area in inspirium AP Valsalva : jugular vein’s anteroposterior diameter in Valsalva LL Valsalva : jugular vein’s laterolateral diameter in Valsalva Aspect Valsalva : AP Valsalva / LL Valsalva CSA Valsalva : jugular vein’s cross section area in Valsalva Cava Resting : caval anteroposterior diameter resting Cava Inspirium : caval anteroposterior diameter in inspirium Cava Collapsibility Index (CCI) : (Cava Resting - Cava Inspirium) / Cava Resting % Jugular vein Collapsibility Index (JCI) : (AP Resting - AP Inspirium) / AP Resting % Jugular Vein Distension Ratio (JVD Ratio) : AP Valsalva / AP Resting CSA Ratio : CSA Valsalva / CSA Resting Data analysis Data were collected with Microsoft Excel, analysed with R Studio and JASP. Numeric variables with normal distribution (determined using Shapiro-Wilks test) are expressed as Mean (and standard deviation, SD), analysed with Student’s T test and Pearson correlation. Numeric variables with non-normal distribution are expressed as Median (and interquartile range), analysed with Wilcoxon test, Kruskal-Wallis test and Spearman correlation. Nominal variables are expressed as n (%) and analysed with F test or chi-square test. A p<0.05 was considered as statistically significant. Given the exploratory nature of this pilot study and the large number of ultrasonographic variables analysed, no formal adjustment for multiple comparisons was performed. The analyses should therefore be considered hypothesis-generating. Due to the observation of collapsed jugular vein after HD session, we needed to face the presence of zeros among denominators of the ratios we calculated. Since we demonstrated a significant correlation between the diameters of the jugular vein and patients’ volume overload, we deemed that excluding patients with collapsed jugular vein from the analysis would have resulted in a significant loss of information and, subsequently, would have distorted study’s results. For this reason, we defined the following conventions: A collapsed jugular vein is defined when the AP diameter is 0 The Aspect Ratio of a collapsed jugular vein is defined as 0 The JVD ratio’s denominator for a collapsed-at-rest jugular vein is 0.1 The CSA ratio’s denominator for a collapsed-at-rest jugular vein is 0.005 The Collapsibility Index of a collapsed-at-rest jugular vein is 100 Temporal stability of measurements was evaluated using linear regression of each parameter against acquisition order. All measurements were continuous and obtained by a single operator under standardized conditions. Regression analyses were performed, to assess potential learning effects, fatigue, or instrument drift over time. RESULTS Study population 57 patients were screened. 5 patients were excluded because of the prescription of non ultrafiltrative treatments. 3 patients were excluded because of jugular thrombosis history. 49 patients were enrolled. OVERALL (N=49) Age (y), Median (Q1, Q3) 76 (66, 83) Sex (M), n (%) 34 (69.4%) BMI , Median (Q1, Q3) 23.72 (22.30, 26.19) BSA, Median (Q1, Q3) 1.75 (1.65, 1.85) Dialytic Vintage (m), Median (Q1, Q3) 33.00 (9.00, 48.00) Kidney Disease, n (%) ADPKD CAKUT associated CKD DKD Glomerulonephritis Myeloma Kidney Tubulointerstitial Nephropathy Vascular Others Unknown 1 (2.0%) 2 (4.1%) 13 (26.5%) 3 (6.2%) 2 (4.1%) 2 (4.1%) 4 (8.2%) 1 (2.0%) 21 (42.9%) Diabetes Mellitus, n (%) 17 (34.7%) Hypertension, n (%) 42 (85.7%) Cardiopathy, n (%) Amiloidosis 2 (4.1%) Chronic Ischemic Cardiopathy 12 (24.5%) Hypertensive 24 (48.9%) Valvular 3 (6.1%) No 8 (16.3%) Chronic Heart Failure, n (%) HFpEF 14 (28.6%) HFrEF 7 (14.3%) No 28 (57.1%) Vascular Access, n (%) AVF 34 (69.4%) CVC 15 (30.6%) Interdialytic weight gain (Kg), Median (Q1, Q3) 1.9 (1.6, 3.0) Delta on dry weight (Kg), Median (Q1, Q3) 2.3 (1.7, 3.6) Delta on dry weight (%), Median (Q1, Q3) 3.4 (2.4, 5.5) Pre-HD blood pressure (mmHg), Median (Q1, Q3) SBP 135.5 (121.5, 150.0) DBP 70.0 (60.0, 75.5) Post-HD blood pressure (mmHg), Median (Q1, Q3) SBP 134.5 (118.0, 150.0) DBP 70.0 (60.0, 80.0) Chronic Hypotension, n (%) 2 (4.1%) Ultrafiltration (L), Median (Q1, Q3) 1.9 (1.3, 2.5) Ultrafiltration (mL/Kg/h), Median (Q1, Q3) 7.89 (5.35, 10.61) Studied Jugular Vein, n (%) DX 33 (67.3%) SN 16 (32.7%) Accomplished IVC ultrasonography , n (%) 42 (85.7%) Accomplished IJV ultrasonography , n (%) 49 (100%) Intradialytic Hypotension, n (%) Grade 1 (Decrease of 20 mmHg in SBP with symptoms) 13 (26.5%) Grade 2 (SBP < 90 mmHg) 1 (2.0%) Grade 3 (Shock) 0 (0.0%) Tab 1: Study population Internal Jugular Vein ultrasonography was successfully accomplished in all patients. Inferior Vena Cava ultrasonography was successfully accomplished in 42 patients (85.7%). In the supplementary appendix is reported the descriptive statistics for each ultrasonographic variable. Temporal effect Linear regression over acquisition order revealed significant temporal trends for several parameters, with the strongest effect for LL resting post (b = 0.160; 95% CI 0.070–0.249; R² = 0.214, p < 0.001). Moderate trends were observed for AP and LL resting pre, CSA resting pre, AP and CSA Valsalva pre, CSA resting post, and LL and CSA Valsalva post (R² 0.10–0.17; p < 0.05–0.01). Effects were minimal or absent for measurements in inspirium, AP Valsalva post, and AP resting post. Influence on ultrasonographic variables Stratification analysis and correlation matrix, which are reported in detail in the supplementary appendix, demonstrate that pre-HD IJV ultrasonographic parameters are not influenced by BSA, BMI, Age, Sex, the laterality of the studied vein (right or left internal jugular vein), the presence of an arteriovenous fistula (AVF), the presence of chronic heart failure, the presence of AF. We only could detect weak and barely significant correlations between a minority of post-HD sampled parameters (LL Resting Post-HD, AP Valsalva Post-HD, Aspect Valsalva Post-HD) and BMI. Correlation with volume overload We performed a correlation analysis between the ultrasonographic variables collected in the pre-HD examination and interdialytic weight gain, absolute delta on dry weight and percentual delta on dry weight. IJV diameters and cross section area in both resting and inspirium showed a strongly significant, moderate, positive correlation with delta on dry weight, while IJV’s diameters and cross section area in Valsalva did not show any correlation with volume overload. IJV aspect ratio did not show any correlation with volume overload. JVD Ratio and CSA Ratio showed a highly significant, moderate, negative correlation with delta on dry weight. Linear regression models were fitted between delta on dry weight and every significantly correlated ultrasonographic variable (Tab 8). All models showed a fair significance (F-statistic values between 8 and 21) but poor fit (maximum R 2 was 0.305). The multivariate analysis failed to significantly increase predictive performance, which remained poor (R 2 was 0.473 for predicting absolute delta on dry weight, 0.335 for predicting percentual delta on dry weight). Interdialytic weight gain was mildly correlated with ultrasonographic variables. Change of ultrasonographic parameters in response to treatment All ultrasonographic parameters showed significant changes between pre-HD and post-HD, except for LL Valsalva and CSA Valsalva. OVERALL (N=49) AP Resting Pre (mm) , Median (Q1, Q3) 7.70 (3.90, 10.40) LL Resting Pre (mm) , Median (Q1, Q3) 10.40 (7.70, 13.60) Aspect Resting Pre , Median (Q1, Q3) 0.72 (0.61, 0.88) CSA Resting Pre (cm 2 ) , Median (Q1, Q3) 0.61 (0.20, 1.14) AP Inspirium Pre (mm) , Median (Q1, Q3) 4.00 (1.70, 6.30) LL Inspirium Pre (mm) , Median (Q1, Q3) 7.30 (3.30, 10.00) Aspect Inspirium Pre , Median (Q1, Q3) 0.60 (0.18, 0.75) CSA Inspirium Pre (cm 2 ) , Median (Q1, Q3) 0.18 (0.07, 0.61) AP Valsalva Pre (mm) , Median (Q1, Q3) 12.80 (10.60, 14.30) LL Valsalva Pre (mm) , Median (Q1, Q3) 16.20 (13.40, 19.70) Aspect Valsalva Pre , Median (Q1, Q3) 0.80 (0.70, 0.92) CSA Valsalva Pre (cm 2 ) , Median (Q1, Q3) 1.75 (1.12, 2.23) Cava Resting Pre (mm) , Median (Q1, Q3) 15.80 (11.88, 21.75) Cava Inspirium Pre (mm) , Median (Q1, Q3) 12.15 (6.78, 16.12) CCI Pre , Median (Q1, Q3) 28.82 (18.57, 40.25) JCI pre , Median (Q1, Q3) 49.33 (30.00, 85.96) JVD Ratio Pre , Median (Q1, Q3) 1.52 (1.30, 2.74) CSA Ratio Pre , Median (Q1, Q3) 2.28 (1.58, 4.67) AP Resting Post (mm) , Median (Q1, Q3) 3.60 (2.30, 6.50) LL Resting Post (mm) , Median (Q1, Q3) 8.70 (5.90, 11.70) Aspect Resting Post , Median (Q1, Q3) 0.55 (0.35, 0.62) CSA Resting Post (cm 2 ) , Median (Q1, Q3) 0.21 (0.13, 0.64) AP Inspirium Post (mm) , Median (Q1, Q3) 0.10 (0.00, 3.30) LL Inspirium Post (mm) , Median (Q1, Q3) 0.00 (0.00, 6.70) Aspect Inspirium Post , Median (Q1, Q3) 0.00 (0.00, 0.53) CSA Inspirium Post (cm 2 ) , Median (Q1, Q3) 0.00 (0.00, 0.19) AP Valsalva Post (mm) , Median (Q1, Q3) 12.60 (9.30, 14.10) LL Valsalva Post (mm) , Median (Q1, Q3) 16.80 (12.20, 20.00) Aspect Valsalva Post , Median (Q1, Q3) 0.76 (0.68, 0.83) CSA Valsalva Post (cm 2 ) , Median (Q1, Q3) 1.60 (0.92, 2.28) Cava Resting Post (mm) , Median (Q1, Q3) 11.25 (7.88, 14.33) Cava Inspirium Post (mm) , Median (Q1, Q3) 5.75 (3.00, 9.40) CCI Post , Median (Q1, Q3) 44.58 (31.85, 59.47) JCI Post , Median (Q1, Q3) 100.00 (46.18, 100.00) JVD Ratio Post , Median (Q1, Q3) 2.62 (1.66, 4.20) CSA Ratio Post , Median (Q1, Q3) 4.29 (2.93, 12.50) Tab. 2: Descriptive. However, we couldn’t define any correlation between the absolute ultrafiltration, the ultrafiltration rate (mL/Kg/h) and the ultrasonographic parameters after HD session. Moreover, we couldn’t define any correlation between the ultrafiltration and the percentual change of the ultrasonographic parameters between pre-HD and post-HD. Interestingly, we detected a fair rate of collapsed IJV resting post-HD (8.1%), whereas no patient showed collapsed IJV at rest pre-HD. DISCUSSION Scientific contributions and study limitations As presented in the introduction, there’s a lack of literature regarding the use of IJV ultrasound in haemodialysis, since the limited studies confirmed that IJV can estimate central venous pressure, but don’t provide valuable information for clinical practice. To the best of our knowledge, this is the first study designed to advance the implementation of jugular vein ultrasonography in clinical practice. For this purpose, we collected a considerable amount of data including 36 ultrasonographic variables to identify parameters that may play a role in the clinical practice. The choice to evaluate a consistent volume of data, driven by the limited evidence, confers further strength to our work. Therefore, we hold that scientific contribution of the present study could be relevant. The main limitation of our work is the small sample size: although 49 patients constitute a relevant sample in the haemodialysis setting, the most relevant studies on IJV ultrasound in the cardiologic setting were conducted on larger cohorts [21]. Another limitation of the study is the detection of temporal trends. Several static parameters showed significant effects consistent with a learning curve, however, predominantly in measurements of limited utility. Importantly, JVD ratio and CSA ratio were not affected by acquisition order, suggesting that derivation mitigates the impact of temporal effects and remains robust for longitudinal and inter-condition comparisons. Therefore, the power of our results is limited. Influence on ultrasonographic parameters Prior to proceeding to the clinical endpoints, we considered it crucial to define the reliability of the IJV ultrasonography in our patients. Besides age, sex, BMI and BSA, we considered many potential sources of bias. First, the laterality of the observed IJV, since many patients are treated by a central venous catheter, usually placed in the right jugular vein, which constitutes a relevant limitation to the ultrasonographic examination. Then, the presence of an AVF, an arterialized venous vessel characterized by an elevated flow that drains immediately before or after the IJV. Furthermore, we considered it necessary to verify whether the presence of HF could systematically bias ultrasonographic evaluation regardless of volume overload and/or ultrafiltration rate. Last, AF, which implies the lack of atrial systole. Our results demonstrate that IJV ultrasonographic evaluation is not influenced by these variables. To the best of our knowledge, ours is the first study that evaluates the influence of these variables on IJV ultrasonographic diameters and surface. Volume overload estimation and dry weight assessment As stated in the background, IJV ultrasound is commonly used in the volume status assessment since many studies demonstrated that IJV static measurements (diameters, aspect ratio) can estimate central venous pressure (CVP), while dynamic measurements (JVD ratio and JCI) can predict response to decongestive treatments [24]. Our results identify a set of variables which are correlated with delta on dry weight, estimating the entity of fluid overload. However, even if statistically significant, the strength of these correlations is globally moderate, and the models fitted to predict delta on dry weight basing on ultrasonographic variables fit poorly. We found that delta on dry weight was positively correlated with IJV diameters and CSA at rest and in inspirium, but not with IJV Aspect Ratio, which was identified by Sekiguchi et al [22] as estimator of CVP. These results could be explained considering that the physiology of patients receiving chronic haemodialysis adapts to significant fluctuations in intravascular volume through complex adaptations involving both the interstitial space and the venous system to maintain cardiovascular homeostasis avoiding excessive rise in central venous pression [25-26]. The most important result, in our opinion, is that the strongest correlation with volume overload was found for JVD Ratio. JVD ratio was thoroughly studied by Pellicori et al. in a population of patients with chronic heart failure (HF). First, they associated a decrease of JVD Ratio with higher NT-proBNP values, more severe right ventricular disfunction and increased pulmonary pressures [27]. Then, in a larger cohort, they associated a JVD Ratio < 4 to an increased HR for a composite of death and hospitalization for HF. In this study, the stratification analysis based on JVD Ratio terciles showed that the outcome of patients with higher JVD Ratio was the best, comparable with the outcome of a control population, while the outcome of patients with lower JVD Ratio was the worst [28]. Our cohort’s pre-HD JVD ratios were far lower compared with the values reported by Pellicori et al. After the treatment, we demonstrated that JVD Ratio raises, however, most of our patients still have a JVD Ratio < 4 even after the treatment. We could state that this observation is consistent with the increased CV risk of patients receiving haemodialysis, but this hypothesis should be confirmed with further studies since Pellicori et al. excluded from their studies patients with severe CKD. Therefore, we state that IJV diameters and CSA, measured both in resting and inspirium, can be useful for longitudinal monitoring of patients and dry weight successive assessments, once the baseline is established, but these variables can’t estimate delta on dry weight in a single-point evaluation. For this purpose, JVD Ratio could be used, once the outcome predictive value is validated in a cohort of CKD G5D patients. Treatment evaluation While estimators of central venous pressure (IJV Aspect, IVC diameters and CCI) are not correlated with volume overload, we demonstrated that these parameters decrease between pre- and post-HD. We previously discussed that JVD ratio increases between pre- and post-HD. We demonstrated that CSA Ratio increases between pre- and post-HD (Fig 7). CSA ratio change was correlated by Fatima et al. to CVP decrease during the decongestive treatment of acute HF [29]. Therefore, our results are consistent with a decrease in CVP consequent to the haemodialytic treatment that was demonstrated by Posada-Martinez et al. [30]. Our findings are in contrast with the observations of Ravi et al. [8] that didn’t report significant changes in CSA between pre- and post-HD. However, Ravi et al. sampled IJV in different positions compared to our study: authors studied IJV just below the jaw and at the level of the clavicle. At these points, however, the vein respectively exits the thoracic outlet through a physiologically ecstatic region (inferior bulb) and receive the anastomosis with the common facial vein. Even if we demonstrated significant changes in most ultrasonographic variables between pre- and post-HD, we couldn’t establish a correlation between these variables and the respective changes and both the magnitude and rate of ultrafiltration. This result can be accounted for by the substantial interindividual differences in treatment compensation which involves complex physiological adaptations, as previously discussed [25-26]. CONCLUSIONS IJV ultrasonography is a minimally invasive exam characterized by a highly practical feasibility in the setting of chronic haemodialysis and high reliability, since observations are not biased by the laterality of the observed jugular vein, sex, BMI, BSA, the presence of AVF and the presence of HF. IJV measurements (diameters and cross section area, measured both at rest and inspirium), could be included in the longitudinal monitoring of patients and provide useful information for dry weight assessment as they are positively correlated with delta on dry weight. Besides statical measurements, JVD Ratio and CSA Ratio provide further information as they are negatively correlated with delta on dry weight. JVD ratio could be used to estimate CV risk related to volume overload of patients, but the predictive value of this parameter should be confirmed in a cohort of patients receiving haemodialysis. Once confirmed, JVD Ratio could be used to evaluate the adequacy of dry weight in a single point evaluation. Because of the exploratory design and the multiple comparisons performed, some statistically significant findings may represent false-positive results. Therefore, our findings should be interpreted cautiously and require validation in larger confirmatory studies. Declarations ADDITIONAL INFORMATIONS The authors declare declare no competing interests. No funding was received for the present study. Author Contribution Alessandro Tomassetti: Idealization, Conceptualization, Draft Writing, equal contribution with Daniele VetranoDaniele Vetrano: Idealization, Conceptualization, Data Analysis, Draft Writing, equal contribution with Alessandro TomassettiNicola Parenti: Idealization, Conceptualization, Project supervisionVittorio Dalmastri: Idealization, Conceptualization, Project supervisionGiuseppe Possente: Idealization, Conceptualization, Draft writingMichele Provenzano: Conceptualization, Data Analysis, Draft writingMarcello Demetri: Data Analysis, Project SupervisionIrene Capelli, Giorgia Comai, Fulvia Zappulo, Mauro Silingardi: Conceptualization, Formal approvalGaetano La Manna: Idealization, Conceptualization, Formal approval, Project director Data Availability The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. References Li T, Wilcox CS, Lipkowitz MS, Gordon-Cappitelli J, Dragoi S. Rationale and Strategies for Preserving Residual Kidney Function in Dialysis Patients. Am J Nephrol. 2019;50(6):411-421. doi:10.1159/000503805 Himmelfarb J, Vanholder R, Mehrotra R, Tonelli M. The current and future landscape of dialysis. Nat Rev Nephrol. 2020;16(10):573-585. doi:10.1038/s41581-020-0315-4 Pereira M, Tocino MLS, Mas-Fontao S, et al. Dependency and frailty in the older haemodialysis patient. BMC Geriatr. 2024;24(1):416. Published 2024 May 10. doi:10.1186/s12877-024-04973-8 McIntyre CW. Haemodialysis-induced myocardial stunning in chronic kidney disease - a new aspect of cardiovascular disease. Blood Purif. 2010;29(2):105-110. doi:10.1159/000245634 Stegmayr BG. Ultrafiltration and dry weight-what are the cardiovascular effects?. Artif Organs. 2003;27(3):227-229. doi:10.1046/j.1525-1594.2003.07205.x Zoccali C, Mallamaci F, Picano E. Detecting and Treating Lung Congestion with Kidney Failure. Clin J Am Soc Nephrol. 2022;17(5):757-765. doi:10.2215/CJN.14591121 Noble VE, Murray AF, Capp R, Sylvia-Reardon MH, Steele DJR, Liteplo A. Ultrasound assessment for extravascular lung water in patients undergoing hemodialysis. Time course for resolution. Chest. 2009;135(6):1433-1439. doi:10.1378/chest.08-1811 Ravi KS, Espersen C, Curtis KA, Cunningham JW, Jering KS, Prasad NG, Platz E, Mc Causland FR. Temporal Changes in Electrolytes, Acid-Base, QTc Duration, and Point-of-Care Ultrasound during Inpatient Hemodialysis Sessions. Kidney360. 2022 May 10;3(7):1217-1227. doi: 10.34067/KID.0001652022. PMID: 35919528; PMCID: PMC9337888. Ciozda W, Kedan I, Kehl DW, Zimmer R, Khandwalla R, Kimchi A. The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure. Cardiovasc Ultrasound. 2016;14(1):33. Published 2016 Aug 20. doi:10.1186/s12947-016-0076-1 Ekinci C, Karabork M, Siriopol D, Dincer N, Covic A, Kanbay M. Effects of Volume Overload and Current Techniques for the Assessment of Fluid Status in Patients with Renal Disease. Blood Purif. 2018;46(1):34-47. doi:10.1159/000487702 Di Nicolò P, Tavazzi G, Nannoni L, Corradi F. Inferior Vena Cava Ultrasonography for Volume Status Evaluation: An Intriguing Promise Never Fulfilled. J Clin Med. 2023 Mar 13;12(6):2217. doi: 10.3390/jcm12062217. PMID: 36983218; PMCID: PMC10053997. Millington SJ, Koenig S. Ultrasound Assessment of the Inferior Vena Cava for Fluid Responsiveness: Making the Case for Skepticism. J Intensive Care Med. 2021;36(10):1223-1227. doi:10.1177/08850666211024176 Koratala A, Romero-González G, Soliman-Aboumarie H, Kazory A. Unlocking the Potential of VExUS in Assessing Venous Congestion: The Art of Doing It Right. Cardiorenal Med. 2024;14(1):350-374. doi:10.1159/000539469 Siva B, Hunt A, Boudville N. The sensitivity and specificity of ultrasound estimation of central venous pressure using the internal jugular vein. J Crit Care. 2012;27(3):. doi:10.1016/j.jcrc.2011.09.008 Chayapinun V, Koratala A, Assavapokee T. Seeing beneath the surface: Harnessing point-of-care ultrasound for internal jugular vein evaluation. World J Cardiol. 2024;16(2):73-79. doi:10.4330/wjc.v16.i2.73 Hossein-Nejad H, Mohammadinejad P, Ahmadi F. Internal jugular vein/common carotid artery cross-sectional area ratio and central venous pressure. J Clin Ultrasound. 2016;44(5):312-318. doi:10.1002/jcu.22339 Prekker ME, Scott NL, Hart D, Sprenkle MD, Leatherman JW. Point-of-care ultrasound to estimate central venous pressure: a comparison of three techniques. Crit Care Med. 2013;41(3):833-841. doi:10.1097/CCM.0b013e31827466b Ammirati E, Marchetti D, Colombo G, et al. Estimation of Right Atrial Pressure by Ultrasound-Assessed Jugular Vein Distensibility in Patients With Heart Failure. Circ Heart Fail. 2024;17(2):e010973. doi:10.1161/CIRCHEARTFAILURE.123.010973 Vaidya GN, Kolodziej A, Stoner B, Galaviz JV, Cao X, Heier K, Thompson M, Birks E, Campbell K. Bedside ultrasound of the internal jugular vein to assess fluid status and right ventricular function: The POCUS-JVD study. Am J Emerg Med. 2023;70:151–156. doi: 10.1016/j.ajem.2023.05.042 Guarracino F, Ferro B, Forfori F, Bertini P, Magliacano L, Pinsky MR. Jugular vein distensibility predicts fluid responsiveness in septic patients. Crit Care. 2014;18:647. doi: 10.1186/s13054-014-0647-1. Chaudhary R, Sukhi A, Simon MA, Villanueva FS, Pacella JJ. Role of Internal Jugular Venous Ultrasound in suspected or confirmed Heart Failure: A Systematic Review. J Card Fail. 2022;28(4):639-649. doi:10.1016/j.cardfail.2021.08.009 Sekiguchi H, Seaburg LA, Suzuki J, et al. Central venous pressure and ultrasonographic measurement correlation and their associations with intradialytic adverse events in hospitalized patients: A prospective observational study. J Crit Care. 2018 Apr;44:168-174. doi:10.1016/j.jcrc.2017.10.039. Epub 2017 Oct 29. PubMed [citation] PMID:29132056 Kerleroux B, Pasco J, Dupuis M, et al. Ultrasonographic assessment of the internal jugular vein for the estimation of central venous pressure in hemodialysis patients: A preliminary study. J Clin Ultrasound. 2018;46(4):253-258. doi:10.1002/jcu.22571 Gawalkar AA, Batta A. Ultrasound based estimate of central venous pressure: Are we any closer?. World J Cardiol . 2024;16(6):310-313. doi:10.4330/wjc.v16.i6.310 Canaud B, Kooman J, Selby NM, et al. Sodium and water handling during hemodialysis: new pathophysiologic insights and management approaches for improving outcomes in end-stage kidney disease. Kidney Int. 2019;95(2):296-309. doi:10.1016/j.kint.2018.09.024 Pang CC. Autonomic control of the venous system in health and disease: effects of drugs. Pharmacol Ther. 2001;90(2-3):179-230. doi:10.1016/s0163-7258(01)00138-3 Pellicori P, Shah P, Cuthbert J, et al. Prevalence, pattern and clinical relevance of ultrasound indices of congestion in outpatients with heart failure. Eur J Heart Fail. 2019;21(7):904-916. doi:10.1002/ejhf.1383 Pellicori P, Kallvikbacka-Bennett A, Zhang J, et al. Revisiting a classical clinical sign: jugular venous ultrasound. Int J Cardiol. 2014;170(3):364-370. doi:10.1016/j.ijcard.2013.11.015 Fatima S, Lambert W, Nouraie M, et al. Bedside ultrasound to assess acute central venous pressure change during treatment of decompensated heart failure. Int J Cardiol Heart Vasc. 2022 Jun 2;41:101067. doi: 10.1016/j.ijcha.2022.101067. PMID: 35676916; PMCID: PMC9168600. Posada-Martinez EL, Cox ZL, Cano-Nieto MM, et al. Changes in the Inferior Vena Cava Are More Sensitive Than Venous Pressure During Fluid Removal: A Proof-ofConcept Study. J Card Fail. 2023;29(4):463-472. doi:10.1016/j.cardfail.2022.09.012 Additional Declarations No competing interests reported. Supplementary Files Changesbetweenpreandposttreatment.pptx Influenceonultrasonographicparameters.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 15 Apr, 2026 Reviews received at journal 15 Apr, 2026 Reviews received at journal 07 Apr, 2026 Reviewers agreed at journal 31 Mar, 2026 Reviewers agreed at journal 31 Mar, 2026 Reviewers invited by journal 31 Mar, 2026 Editor assigned by journal 31 Mar, 2026 Editor invited by journal 20 Mar, 2026 Submission checks completed at journal 18 Mar, 2026 First submitted to journal 18 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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19:23:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9141317/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9141317/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106289035,"identity":"f0b729f9-e1bf-4703-889f-f5ed47060cfb","added_by":"auto","created_at":"2026-04-07 07:27:58","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":44344,"visible":true,"origin":"","legend":"\u003cp\u003eStudy protocol flow chart\u003c/p\u003e","description":"","filename":"fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9141317/v1/630a809b77c73d4bbd311441.jpg"},{"id":106289083,"identity":"55663d81-3bc3-45a4-ae98-3ee277ca8b43","added_by":"auto","created_at":"2026-04-07 07:28:22","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":72590,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasonographic parameters\u003c/p\u003e","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9141317/v1/f9e4642b265cb3db480f8b7d.jpg"},{"id":106289029,"identity":"686d08ed-459e-4755-8a11-7500e26cef90","added_by":"auto","created_at":"2026-04-07 07:27:57","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":542399,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation heatmap of pre-HD ultrasonographic parameters and volume overload\u003c/p\u003e","description":"","filename":"fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9141317/v1/6712ab6bd28e178d2126e9b7.jpg"},{"id":106289034,"identity":"57ed6838-82b6-4138-a8d4-100e9c63e5b1","added_by":"auto","created_at":"2026-04-07 07:27:57","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":392694,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation heatmap of post-HD ultrasonographic parameters and fluid removal volume\u003c/p\u003e","description":"","filename":"fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9141317/v1/3aa6455cd18b04827a41414f.jpg"},{"id":106289010,"identity":"d4982fb4-c660-4dae-b77e-f1fc78b6906c","added_by":"auto","created_at":"2026-04-07 07:27:51","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":394241,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation heatmap of changes in ultrasonographic parameters between pre- and post-HD.\u003c/p\u003e","description":"","filename":"fig5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9141317/v1/2f58863f9c79503730f9b309.jpg"},{"id":106289021,"identity":"f66f59d8-cf8b-4cae-9959-c32bae4cfd1e","added_by":"auto","created_at":"2026-04-07 07:27:54","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":59531,"visible":true,"origin":"","legend":"\u003cp\u003e\u0026nbsp;Legend not included with this version.\u003c/p\u003e","description":"","filename":"fig6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9141317/v1/ef3a5b7c7f80abf94c5f3815.jpg"},{"id":106289202,"identity":"360765e1-73bd-4a21-bb27-673e9d21ec5f","added_by":"auto","created_at":"2026-04-07 07:29:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2858704,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9141317/v1/6216876d-2201-42b5-a75c-bf76f601529a.pdf"},{"id":106289039,"identity":"386464d3-3c0f-4d85-836f-47d3cacfce7a","added_by":"auto","created_at":"2026-04-07 07:28:03","extension":"pptx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":111767,"visible":true,"origin":"","legend":"","description":"","filename":"Changesbetweenpreandposttreatment.pptx","url":"https://assets-eu.researchsquare.com/files/rs-9141317/v1/5795958e8c6b5b81af1db36a.pptx"},{"id":106289082,"identity":"13718615-ad39-42c0-bbcc-efc3f962b6ff","added_by":"auto","created_at":"2026-04-07 07:28:22","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":48809,"visible":true,"origin":"","legend":"","description":"","filename":"Influenceonultrasonographicparameters.docx","url":"https://assets-eu.researchsquare.com/files/rs-9141317/v1/b56e7314f406925a4cb40a39.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Internal Jugular Vein Ultrasound for Fluid Status Assessment in Maintenance Haemodialysis: A Prospective Pilot Exploratory Study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eIn patients with end-stage renal disease treated with chronic haemodialysis residual renal function is usually insufficient to maintain hydro-saline homeostasis, thus leading to the need of ultrafiltration to avoid volume overload. This treatment is characterized by a narrow therapeutic index, since the slightest under- or overdosage of ultrafiltration could impact on patients\u0026rsquo; outcome. Indeed, while chronic sodium overload induces cardiac remodelling resulting in an enhanced CV risk [1-2], even a subclinical ultrafiltration (UF) overdosage causes visceral hypoperfusion that leads to loss of the residual renal function, myocardial stunning and cerebral damage [3-5].\u003c/p\u003e\n\u003cp\u003eFurthermore, population on maintenance haemodialysis is becoming increasingly complex and frail.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFrailty and comorbidities complicate volume status evaluation because of the coexistence of condition such as malnutrition, sarcopenia, chronic heart failure, chronic inflammation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong the wide array of instruments that physicians can use to improve the precision of the dry weight definition and consequent ultrafiltration prescription, ultrasonography is gaining raising interest due to the well-known winning characteristics of Point-of-Care (PoCUS) examination and the development of techniques that can provide repeatable results [6-10].\u003c/p\u003e\n\u003cp\u003eGiven the physiological characteristics of the venous system, the ultrasonographic evaluation of the inferior vena cava (IVC) is a pillar of the PoCUS evaluation of fluid balance, routinary used by physicians in many branches of the clinical practice. However, IVC ultrasonography reliability is still debated in literature [11-13].\u003c/p\u003e\n\u003cp\u003eFor this reason, many authors studied the internal jugular vein (IJV) ultrasonography as a marker of volume status, mainly in the intensive care and cardiologic settings [14-20].\u003c/p\u003e\n\u003cp\u003eThe IJV has been mainly studied to provide a measure of central venous pressure (CVP), but many studies performed in the cardiologic setting demonstrated that IJV ultrasound could provide further information with clinical relevance (i.e. outcome predictors) which make this exam suitable for the implementation in clinical algorithms for the evaluation of patients with HF [21].\u003c/p\u003e\n\u003cp\u003eDespite the rapid and easy execution (due to the superficial anatomical location of the IJV) and the interesting evidence that will be further discussed besides our results, only two studies investigated the role of this exam in the setting of chronic haemodialysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSekiguchi et al. demonstrated that an elevated CVP could be diagnosed by the evaluation of the internal jugular vein aspect ratio [22].\u003c/p\u003e\n\u003cp\u003eKerleroux et al. estimated the CVP of 22 patients by measuring the height of the internal jugular vein collapsing, determined via ultrasonography [23].\u003c/p\u003e\n\u003cp\u003eThe two studies aimed to identify a parametric predictor of the CVP. Consequently, these works suffer from two main limitations: first, authors included only patients receiving haemodialysis via CVC, then, these works provided only a limited amount of data.\u003c/p\u003e\n\u003cp\u003eTherefore, we performed an observational prospective study to investigate which role could play the ultrasonography of the internal jugular vein in the setting of maintenance haemodialysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTUDY OBJECTIVES\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study aims:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eTo assess whether inferior jugular vein ultrasonography is biased by the laterality of the studied vein (right or left internal jugular vein), the presence of an arteriovenous fistula (AVF) or central venous catheter (CVC), the presence of chronic heart failure, the presence of atrial fibrillation (AF), sex, age, body mass index (BMI) and body surface area (BSA)\u003c/li\u003e\n \u003cli\u003eTo find a correlation between the pre dialysis volume overload and the ultrasonographic parameters\u003c/li\u003e\n \u003cli\u003eTo describe the variation of ultrasonographic parameters in response to the haemodialytic treatment\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"METHODS","content":"\u003cp\u003eWe conducted a prospective observational trial performed in the Haemodialysis Centre - Ospedale Maggiore in Bologna, Italy (IT).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients were included after written informed consent. The study was approved by The Ethical Committee CE-AVEC, approval number 455-2025-OSS-AUSLBO. The study was carried out according to the Helsinki Declaration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe only inclusion criterion was the CKD G5D receiving regular maintenance haemodialysis in our centre.\u003c/p\u003e\n\u003cp\u003eThe exclusion criteria were:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ePathological history of Internal Jugular Vein thrombosis, including catheter-related thrombosis\u003c/li\u003e\n \u003cli\u003eInsufficient compliance\u003c/li\u003e\n \u003cli\u003eRoutinary prescription of non ultrafiltrative treatments.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003ePatients were enrolled between July, 1\u003csup\u003est\u003c/sup\u003e, 2024 and October, 1\u003csup\u003est\u003c/sup\u003e, 2024.\u003c/p\u003e\n\u003cp\u003eIn Fig.1 is summarized the study proceedings. After the enrolment, patients undergo a medical examination before the scheduled dialysis session in which past medical history and interdialytic anamnesis is compiled, physical examination is performed, dry weight is redefined or confirmed. Then, patients undergo a first ultrasonographic examination, as will be further discussed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAfter the clinical and ultrasonographic evaluation, the haemodialysis session gets started and patients is connected to the extracorporeal circuit.\u003c/p\u003e\n\u003cp\u003eAt the end of the treatment, before the disconnection from the extracorporeal circuit, a second ultrasonographic examination is performed and monitoring data are collected.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUltrasonographic Examination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the ultrasonographic examinations were conducted by a single operator, using Mindray M7 or Esaote MyLab X Pro 30 ultrasonographers, convex 1-6 MHz and linear 3-10 MHz probes and factory presets for the evaluation of abdomen and venous vessels.\u003c/p\u003e\n\u003cp\u003eThe ultrasonographic evaluations were conducted as follows:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ePatient in supine decubitus, 45\u0026deg; tilt.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThe internal right jugular vein is identified with a linear 3-10 MHz probe that gets positioned 2 cm distant from the clavicle in a transverse scan. If the right internal jugular vein was cannulated, left internal jugular vein is evaluated.\u003c/li\u003e\n \u003cli\u003eThe following measures are taken in inspirium and resting: anteroposterior and laterolateral diameters (leading edge to leading edge technique); cross section area.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePatient is asked to perform a Valsalva maneuver\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDuring the Valsalva maneuver the following measures are taken: anteroposterior and laterolateral diameters (leading edge to leading edge technique); cross section area.\u003c/li\u003e\n \u003cli\u003eUltrasonographic evaluation of the inferior vena cava.\u003c/li\u003e\n \u003cli\u003ePatient in supine decubitus.\u003c/li\u003e\n \u003cli\u003eThe inferior vena cava is identified with a convex 1-6 MHz probe that gets positioned in subxyphoid sagittal scan, parallel with the vein sagittal axis.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThe anteroposterior diameter, sampled 2-3 cm below diaphragm, is measured in inspirium and resting.\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eUltrasonographic variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe defined the following variables:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eAP Resting\u003c/strong\u003e: jugular vein\u0026rsquo;s anteroposterior diameter resting\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLL Resting\u003c/strong\u003e: jugular vein\u0026rsquo;s laterolateral diameter resting\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAspect Resting\u003c/strong\u003e: AP Resting / LL Resting\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCSA Resting\u003c/strong\u003e: jugular vein\u0026rsquo;s cross section area resting\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAP Inspirium\u003c/strong\u003e: jugular vein\u0026rsquo;s anteroposterior diameter in inspirium\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLL Inspirium\u003c/strong\u003e: jugular vein\u0026rsquo;s laterolateral diameter in inspirium\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAspect Inspirium\u003c/strong\u003e: AP Inspirium / LL Inspirium\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCSA Inspirium\u003c/strong\u003e: jugular vein\u0026rsquo;s cross section area in inspirium\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAP Valsalva\u003c/strong\u003e: jugular vein\u0026rsquo;s anteroposterior diameter in Valsalva\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLL Valsalva\u003c/strong\u003e: jugular vein\u0026rsquo;s laterolateral diameter in Valsalva\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAspect Valsalva\u003c/strong\u003e: AP Valsalva / LL Valsalva\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCSA Valsalva\u003c/strong\u003e: jugular vein\u0026rsquo;s cross section area in Valsalva\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCava Resting\u003c/strong\u003e: caval anteroposterior diameter resting\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCava Inspirium\u003c/strong\u003e: caval anteroposterior diameter in inspirium\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCava Collapsibility Index (CCI)\u003c/strong\u003e: (Cava Resting - Cava Inspirium) / Cava Resting %\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eJugular vein Collapsibility Index (JCI)\u003c/strong\u003e: (AP Resting - AP Inspirium) / AP Resting %\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eJugular Vein Distension Ratio (JVD Ratio)\u003c/strong\u003e: AP Valsalva / AP Resting\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCSA Ratio\u003c/strong\u003e: CSA Valsalva / CSA Resting\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected with Microsoft Excel, analysed with R Studio and JASP.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNumeric variables with normal distribution (determined using Shapiro-Wilks test) are expressed as Mean (and standard deviation, SD), analysed with Student\u0026rsquo;s T test and Pearson correlation.\u003c/p\u003e\n\u003cp\u003eNumeric variables with non-normal distribution are expressed as Median (and interquartile range), analysed with Wilcoxon test, Kruskal-Wallis test and Spearman correlation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNominal variables are expressed as n (%) and analysed with F test or chi-square test.\u003c/p\u003e\n\u003cp\u003eA p\u0026lt;0.05 was considered as statistically significant.\u003c/p\u003e\n\u003cp\u003eGiven the exploratory nature of this pilot study and the large number of ultrasonographic variables analysed, no formal adjustment for multiple comparisons was performed. The analyses should therefore be considered hypothesis-generating.\u003c/p\u003e\n\u003cp\u003eDue to the observation of collapsed jugular vein after HD session, we needed to face the presence of zeros among denominators of the ratios we calculated. Since we demonstrated a significant correlation between the diameters of the jugular vein and patients\u0026rsquo; volume overload, we deemed that excluding patients with collapsed jugular vein from the analysis would have resulted in a significant loss of information and, subsequently, would have distorted study\u0026rsquo;s results.\u003c/p\u003e\n\u003cp\u003eFor this reason, we defined the following conventions:\u003c/p\u003e\n\u003cul class=\"decimal_type\"\u003e\n \u003cli\u003eA collapsed jugular vein is defined when the AP diameter is 0\u003c/li\u003e\n \u003cli\u003eThe Aspect Ratio of a collapsed jugular vein is defined as 0\u003c/li\u003e\n \u003cli\u003eThe JVD ratio\u0026rsquo;s denominator for a collapsed-at-rest jugular vein is 0.1\u003c/li\u003e\n \u003cli\u003eThe CSA ratio\u0026rsquo;s denominator for a collapsed-at-rest jugular vein is 0.005\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThe Collapsibility Index of a collapsed-at-rest jugular vein is 100\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eTemporal stability of measurements was evaluated using linear regression of each parameter against acquisition order. All measurements were continuous and obtained by a single operator under standardized conditions. Regression analyses were performed, to assess potential learning effects, fatigue, or instrument drift over time.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e57 patients were screened. 5 patients were excluded because of the prescription of non ultrafiltrative treatments. 3 patients were excluded because of jugular thrombosis history.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e49 patients were enrolled.\u0026nbsp;\u003c/p\u003e\n\u003ctable style=\"float: ;width: 4.7e+2pt;border: none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOVERALL (N=49)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAge (y),\u003c/strong\u003e Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e76 (66, 83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSex (M),\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34 (69.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23.72 (22.30, 26.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eBSA,\u003c/strong\u003e Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.75 (1.65, 1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDialytic Vintage (m),\u003c/strong\u003e Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33.00 (9.00, 48.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eKidney Disease, n\u0026nbsp;\u003c/strong\u003e(%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;ADPKD\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;CAKUT associated CKD\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;DKD\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Glomerulonephritis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Myeloma Kidney\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Tubulointerstitial Nephropathy\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Vascular\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Others\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (2.0%)\u003c/p\u003e\n \u003cp\u003e2 (4.1%)\u003c/p\u003e\n \u003cp\u003e13 (26.5%)\u003c/p\u003e\n \u003cp\u003e3 (6.2%)\u003c/p\u003e\n \u003cp\u003e2 (4.1%)\u003c/p\u003e\n \u003cp\u003e2 (4.1%)\u003c/p\u003e\n \u003cp\u003e4 (8.2%)\u003c/p\u003e\n \u003cp\u003e1 (2.0%)\u003c/p\u003e\n \u003cp\u003e21 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes Mellitus,\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17 (34.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension,\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e42 (85.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCardiopathy,\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Amiloidosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Chronic Ischemic Cardiopathy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12 (24.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Hypertensive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24 (48.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Valvular\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3 (6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (16.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eChronic Heart Failure,\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;HFpEF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;HFrEF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVascular Access,\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;AVF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34 (69.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e CVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (30.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eInterdialytic weight gain (Kg),\u0026nbsp;\u003c/strong\u003eMedian (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.9 (1.6, 3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDelta on dry weight (Kg),\u003c/strong\u003e Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.3 (1.7, 3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDelta on dry weight (%),\u0026nbsp;\u003c/strong\u003eMedian (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.4 (2.4, 5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePre-HD blood pressure (mmHg),\u0026nbsp;\u003c/strong\u003eMedian (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e135.5 (121.5, 150.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e70.0 (60.0, 75.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePost-HD blood pressure (mmHg),\u0026nbsp;\u003c/strong\u003eMedian (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e134.5 (118.0, 150.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e70.0 (60.0, 80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eChronic Hypotension,\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eUltrafiltration (L),\u003c/strong\u003e Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.9 (1.3, 2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eUltrafiltration (mL/Kg/h),\u0026nbsp;\u003c/strong\u003eMedian (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.89 (5.35, 10.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eStudied Jugular Vein,\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;DX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e33 (67.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;SN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16 (32.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAccomplished IVC ultrasonography\u003c/strong\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e42 (85.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAccomplished IJV ultrasonography\u003c/strong\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIntradialytic Hypotension,\u0026nbsp;\u003c/strong\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGrade 1 (Decrease of 20 mmHg in SBP with symptoms)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (26.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGrade 2 (SBP \u0026lt; 90 mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGrade 3 (Shock)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTab 1: Study population\u003c/p\u003e\n\u003cp\u003eInternal Jugular Vein ultrasonography was successfully accomplished in all patients. Inferior Vena Cava ultrasonography was successfully accomplished in 42 patients (85.7%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the supplementary appendix is reported the descriptive statistics for each ultrasonographic variable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTemporal effect\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLinear regression over acquisition order revealed significant temporal trends for several parameters, with the strongest effect for LL resting post (b = 0.160; 95% CI 0.070\u0026ndash;0.249; R\u0026sup2; = 0.214, p \u0026lt; 0.001). Moderate trends were observed for AP and LL resting pre, CSA resting pre, AP and CSA Valsalva pre, CSA resting post, and LL and CSA Valsalva post (R\u0026sup2; 0.10\u0026ndash;0.17; p \u0026lt; 0.05\u0026ndash;0.01). Effects were minimal or absent for measurements in inspirium, AP Valsalva post, and AP resting post.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInfluence on ultrasonographic variables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStratification analysis and correlation matrix, which are reported in detail in the supplementary appendix, demonstrate that pre-HD IJV ultrasonographic parameters are not influenced by BSA, BMI, Age, Sex, the laterality of the studied vein (right or left internal jugular vein), the presence of an arteriovenous fistula (AVF), the presence of chronic heart failure, the presence of AF. We only could detect weak and barely significant correlations between a minority of post-HD sampled parameters (LL Resting Post-HD, AP Valsalva Post-HD, Aspect Valsalva Post-HD) and BMI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation with volume overload\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe performed a correlation analysis between the ultrasonographic variables collected in the pre-HD examination and interdialytic weight gain, absolute delta on dry weight and percentual delta on dry weight.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIJV diameters and cross section area in both resting and inspirium showed a strongly significant, moderate, positive correlation with delta on dry weight, while IJV\u0026rsquo;s diameters and cross section area in Valsalva did not show any correlation with volume overload. IJV aspect ratio did not show any correlation with volume overload.\u003c/p\u003e\n\u003cp\u003eJVD Ratio and CSA Ratio showed a highly significant, moderate, negative correlation with delta on dry weight.\u003c/p\u003e\n\u003cp\u003eLinear regression models were fitted between delta on dry weight and every significantly correlated ultrasonographic variable (Tab 8). All models showed a fair significance (F-statistic values between 8 and 21) but poor fit (maximum R\u003csup\u003e2\u0026nbsp;\u003c/sup\u003ewas 0.305). The multivariate analysis failed to significantly increase predictive performance, which remained poor (R\u003csup\u003e2\u003c/sup\u003e was 0.473 for predicting absolute delta on dry weight, 0.335 for predicting percentual delta on dry weight).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInterdialytic weight gain was mildly correlated with ultrasonographic variables. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChange of ultrasonographic parameters in response to treatment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll ultrasonographic parameters showed significant changes between pre-HD and post-HD, except for LL Valsalva and CSA Valsalva.\u0026nbsp;\u003c/p\u003e\n\u003ctable style=\"width: 97%;border: none;\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOVERALL (N=49)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAP Resting Pre (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.70 (3.90, 10.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLL Resting Pre (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.40 (7.70, 13.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAspect Resting Pre\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.72 (0.61, 0.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCSA Resting Pre (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.61 (0.20, 1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAP Inspirium Pre (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.00 (1.70, 6.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLL Inspirium Pre (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.30 (3.30, 10.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAspect Inspirium Pre\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.60 (0.18, 0.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCSA Inspirium Pre (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.18 (0.07, 0.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAP Valsalva Pre (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.80 (10.60, 14.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLL Valsalva Pre (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.20 (13.40, 19.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAspect Valsalva Pre\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.80 (0.70, 0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCSA Valsalva Pre (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.75 (1.12, 2.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCava Resting Pre (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.80 (11.88, 21.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCava Inspirium Pre (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.15 (6.78, 16.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCCI Pre\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.82 (18.57, 40.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eJCI pre\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e49.33 (30.00, 85.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eJVD Ratio Pre\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.52 (1.30, 2.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCSA Ratio Pre\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.28 (1.58, 4.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAP Resting Post (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3.60 (2.30, 6.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLL Resting Post (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.70 (5.90, 11.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAspect Resting Post\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.55 (0.35, 0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCSA Resting Post (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.21 (0.13, 0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAP Inspirium Post (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.10 (0.00, 3.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLL Inspirium Post (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.00 (0.00, 6.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAspect Inspirium Post\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.00 (0.00, 0.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCSA Inspirium Post (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.00 (0.00, 0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAP Valsalva Post (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.60 (9.30, 14.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLL Valsalva Post (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16.80 (12.20, 20.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAspect Valsalva Post\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.76 (0.68, 0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCSA Valsalva Post (cm\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.60 (0.92, 2.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCava Resting Post (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.25 (7.88, 14.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCava Inspirium Post (mm)\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5.75 (3.00, 9.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCCI Post\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44.58 (31.85, 59.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eJCI Post\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100.00 (46.18, 100.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eJVD Ratio Post\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.62 (1.66, 4.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCSA Ratio Post\u003c/strong\u003e, Median (Q1, Q3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4.29 (2.93, 12.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTab. 2: Descriptive.\u003c/p\u003e\n\u003cp\u003eHowever, we couldn\u0026rsquo;t define any correlation between the absolute ultrafiltration, the ultrafiltration rate (mL/Kg/h) and the ultrasonographic parameters after HD session. Moreover, we couldn\u0026rsquo;t define any correlation between the ultrafiltration and the percentual change of the ultrasonographic parameters between pre-HD and post-HD.\u003c/p\u003e\n\u003cp\u003eInterestingly, we detected a fair rate of collapsed IJV resting post-HD (8.1%), whereas no patient showed collapsed IJV at rest pre-HD.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e\u003cstrong\u003eScientific contributions and study limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs presented in the introduction, there\u0026rsquo;s a lack of literature regarding the use of IJV ultrasound in haemodialysis, since the limited studies confirmed that IJV can estimate central venous pressure, but don\u0026rsquo;t provide valuable information for clinical practice.\u003c/p\u003e\n\u003cp\u003eTo the best of our knowledge, this is the first study designed to advance the implementation of jugular vein ultrasonography in clinical practice.\u003c/p\u003e\n\u003cp\u003eFor this purpose, we collected a considerable amount of data including 36 ultrasonographic variables to identify parameters that may play a role in the clinical practice.\u003c/p\u003e\n\u003cp\u003eThe choice to evaluate a consistent volume of data, driven by the limited evidence, confers further strength to our work.\u003c/p\u003e\n\u003cp\u003eTherefore, we hold that scientific contribution of the present study could be relevant.\u003c/p\u003e\n\u003cp\u003eThe main limitation of our work is the small sample size: although 49 patients constitute a relevant sample in the haemodialysis setting, the most relevant studies on IJV ultrasound in the cardiologic setting were conducted on larger cohorts [21].\u003c/p\u003e\n\u003cp\u003eAnother limitation of the study is the detection of temporal trends. Several static parameters showed significant effects consistent with a learning curve, however, predominantly in measurements of limited utility. Importantly, JVD ratio and CSA ratio were not affected by acquisition order, suggesting that derivation mitigates the impact of temporal effects and remains robust for longitudinal and inter-condition comparisons.\u003c/p\u003e\n\u003cp\u003eTherefore, the power of our results is limited. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInfluence on ultrasonographic parameters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrior to proceeding to the clinical endpoints, we considered it crucial to define the reliability of the IJV ultrasonography in our patients. Besides age, sex, BMI and BSA, we considered many potential sources of bias.\u003c/p\u003e\n\u003cp\u003eFirst, the laterality of the observed IJV, since many patients are treated by a central venous catheter, usually placed in the right jugular vein, which constitutes a relevant limitation to the ultrasonographic examination. Then, the presence of an AVF, an arterialized venous vessel characterized by an elevated flow that drains immediately before or after the IJV. Furthermore, we considered it necessary to verify whether the presence of HF could systematically bias ultrasonographic evaluation regardless of volume overload and/or ultrafiltration rate. Last, AF, which implies the lack of atrial systole.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur results demonstrate that IJV ultrasonographic evaluation is not influenced by these variables.\u003c/p\u003e\n\u003cp\u003eTo the best of our knowledge, ours is the first study that evaluates the influence of these variables on IJV ultrasonographic diameters and surface.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVolume overload estimation and dry weight assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs stated in the background, IJV ultrasound is commonly used in the volume status assessment since many studies demonstrated that IJV static measurements (diameters, aspect ratio) can estimate central venous pressure (CVP), while dynamic measurements (JVD ratio and JCI) can predict response to decongestive treatments [24].\u003c/p\u003e\n\u003cp\u003eOur results identify a set of variables which are correlated with delta on dry weight, estimating the entity of fluid overload. However, even if statistically significant, the strength of these correlations is globally moderate, and the models fitted to predict delta on dry weight basing on ultrasonographic variables fit poorly.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe found that delta on dry weight was positively correlated with IJV diameters and CSA at rest and in inspirium, but not with IJV Aspect Ratio, which was identified by Sekiguchi et al [22] as estimator of CVP.\u003c/p\u003e\n\u003cp\u003eThese results could be explained considering that the physiology of patients receiving chronic haemodialysis adapts to significant fluctuations in intravascular volume through complex adaptations involving both the interstitial space and the venous system to maintain cardiovascular homeostasis avoiding excessive rise in central venous pression [25-26].\u003c/p\u003e\n\u003cp\u003eThe most important result, in our opinion, is that the strongest correlation with volume overload was found for JVD Ratio.\u003c/p\u003e\n\u003cp\u003eJVD ratio was thoroughly studied by Pellicori et al. in a population of patients with chronic heart failure (HF). First, they associated a decrease of JVD Ratio with higher NT-proBNP values, more severe right ventricular disfunction and increased pulmonary pressures [27].\u003csup\u003e\u0026nbsp;\u003c/sup\u003eThen, in a larger cohort, they associated a JVD Ratio \u0026lt; 4 to an increased HR for a composite of death and hospitalization for HF. In this study, the stratification analysis based on JVD Ratio terciles showed that the outcome of patients with higher JVD Ratio was the best, comparable with the outcome of a control population, while the outcome of patients with lower JVD Ratio was the worst [28].\u003c/p\u003e\n\u003cp\u003eOur cohort\u0026rsquo;s pre-HD JVD ratios were far lower compared with the values reported by Pellicori et al. After the treatment, we demonstrated that JVD Ratio raises, however, most of our patients still have a JVD Ratio \u0026lt; 4 even after the treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe could state that this observation is consistent with the increased CV risk of patients receiving haemodialysis, but this hypothesis should be confirmed with further studies since Pellicori et al. excluded from their studies patients with severe CKD.\u003c/p\u003e\n\u003cp\u003eTherefore, we state that IJV diameters and CSA, measured both in resting and inspirium, can be useful for longitudinal monitoring of patients and dry weight successive assessments, once the baseline is established, but these variables can\u0026rsquo;t estimate delta on dry weight in a single-point evaluation. For this purpose, JVD Ratio could be used, once the outcome predictive value is validated in a cohort of CKD G5D patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment evaluation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile estimators of central venous pressure (IJV Aspect, IVC diameters and CCI) are not correlated with volume overload, we demonstrated that these parameters decrease between pre- and post-HD.\u003c/p\u003e\n\u003cp\u003eWe previously discussed that JVD ratio increases between pre- and post-HD.\u003c/p\u003e\n\u003cp\u003eWe demonstrated that CSA Ratio increases between pre- and post-HD (Fig 7).\u003c/p\u003e\n\u003cp\u003eCSA ratio change was correlated by Fatima et al. to CVP decrease during the decongestive treatment of acute HF [29]. Therefore, our results are consistent with a decrease in CVP consequent to the haemodialytic treatment that was demonstrated by Posada-Martinez et al. [30].\u003c/p\u003e\n\u003cp\u003eOur findings are in contrast with the observations of Ravi et al. [8] that didn\u0026rsquo;t report significant changes in CSA between pre- and post-HD. However, Ravi et al. sampled IJV in different positions compared to our study: authors studied IJV just below the jaw and at the level of the clavicle. At these points, however, the vein respectively exits the thoracic outlet through a physiologically ecstatic region (inferior bulb) and receive the anastomosis with the common facial vein.\u003c/p\u003e\n\u003cp\u003eEven if we demonstrated significant changes in most ultrasonographic variables between pre- and post-HD, we couldn\u0026rsquo;t establish a correlation between these variables and the respective changes and both the magnitude and rate of ultrafiltration.\u003c/p\u003e\n\u003cp\u003eThis result can be accounted for by the substantial interindividual differences in treatment compensation which involves complex physiological adaptations, as previously discussed [25-26].\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eIJV ultrasonography is a minimally invasive exam characterized by a highly practical feasibility in the setting of chronic haemodialysis and high reliability, since observations are not biased by the laterality of the observed jugular vein, sex, BMI, BSA, the presence of AVF and the presence of HF.\u003c/p\u003e\n\u003cp\u003eIJV measurements (diameters and cross section area, measured both at rest and inspirium), could be included in the longitudinal monitoring of patients and provide useful information for dry weight assessment as they are positively correlated with delta on dry weight. Besides statical measurements, JVD Ratio and CSA Ratio provide further information as they are negatively correlated with delta on dry weight.\u003c/p\u003e\n\u003cp\u003eJVD ratio could be used to estimate CV risk related to volume overload of patients, but the predictive value of this parameter should be confirmed in a cohort of patients receiving haemodialysis. Once confirmed, JVD Ratio could be used to evaluate the adequacy of dry weight in a single point evaluation.\u003c/p\u003e\n\u003cp\u003eBecause of the exploratory design and the multiple comparisons performed, some statistically significant findings may represent false-positive results. Therefore, our findings should be interpreted cautiously and require validation in larger confirmatory studies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eADDITIONAL INFORMATIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo funding was received for the present study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAlessandro Tomassetti: Idealization, Conceptualization, Draft Writing, equal contribution with Daniele VetranoDaniele Vetrano: Idealization, Conceptualization, Data Analysis, Draft Writing, equal contribution with Alessandro TomassettiNicola Parenti: Idealization, Conceptualization, Project supervisionVittorio Dalmastri: Idealization, Conceptualization, Project supervisionGiuseppe Possente: Idealization, Conceptualization, Draft writingMichele Provenzano: Conceptualization, Data Analysis, Draft writingMarcello Demetri: Data Analysis, Project SupervisionIrene Capelli, Giorgia Comai, Fulvia Zappulo, Mauro Silingardi: Conceptualization, Formal approvalGaetano La Manna: Idealization, Conceptualization, Formal approval, Project director\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eLi T, Wilcox CS, Lipkowitz MS, Gordon-Cappitelli J, Dragoi S. Rationale and Strategies for Preserving Residual Kidney Function in Dialysis Patients. Am J Nephrol. 2019;50(6):411-421. doi:10.1159/000503805\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHimmelfarb J, Vanholder R, Mehrotra R, Tonelli M. The current and future landscape of dialysis. Nat Rev Nephrol. 2020;16(10):573-585. doi:10.1038/s41581-020-0315-4\u003c/li\u003e\n \u003cli\u003ePereira M, Tocino MLS, Mas-Fontao S, et al. Dependency and frailty in the older haemodialysis patient. BMC Geriatr. 2024;24(1):416. Published 2024 May 10. doi:10.1186/s12877-024-04973-8\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMcIntyre CW. Haemodialysis-induced myocardial stunning in chronic kidney disease - a new aspect of cardiovascular disease. Blood Purif. 2010;29(2):105-110. doi:10.1159/000245634\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eStegmayr BG. Ultrafiltration and dry weight-what are the cardiovascular effects?. Artif Organs. 2003;27(3):227-229. doi:10.1046/j.1525-1594.2003.07205.x\u003c/li\u003e\n \u003cli\u003eZoccali C, Mallamaci F, Picano E. Detecting and Treating Lung Congestion with Kidney Failure. Clin J Am Soc Nephrol. 2022;17(5):757-765. doi:10.2215/CJN.14591121\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eNoble VE, Murray AF, Capp R, Sylvia-Reardon MH, Steele DJR, Liteplo A. Ultrasound assessment for extravascular lung water in patients undergoing hemodialysis. Time course for resolution. Chest. 2009;135(6):1433-1439. doi:10.1378/chest.08-1811\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRavi KS, Espersen C, Curtis KA, Cunningham JW, Jering KS, Prasad NG, Platz E, Mc Causland FR. Temporal Changes in Electrolytes, Acid-Base, QTc Duration, and Point-of-Care Ultrasound during Inpatient Hemodialysis Sessions. Kidney360. 2022 May 10;3(7):1217-1227. doi: 10.34067/KID.0001652022. PMID: 35919528; PMCID: PMC9337888. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCiozda W, Kedan I, Kehl DW, Zimmer R, Khandwalla R, Kimchi A. The efficacy of sonographic measurement of inferior vena cava diameter as an estimate of central venous pressure. Cardiovasc Ultrasound. 2016;14(1):33. Published 2016 Aug 20. doi:10.1186/s12947-016-0076-1 \u0026nbsp;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eEkinci C, Karabork M, Siriopol D, Dincer N, Covic A, Kanbay M. Effects of Volume Overload and Current Techniques for the Assessment of Fluid Status in Patients with Renal Disease. Blood Purif. 2018;46(1):34-47. doi:10.1159/000487702\u003c/li\u003e\n \u003cli\u003eDi Nicol\u0026ograve; P, Tavazzi G, Nannoni L, Corradi F. Inferior Vena Cava Ultrasonography for Volume Status Evaluation: An Intriguing Promise Never Fulfilled. J Clin Med. 2023 Mar 13;12(6):2217. doi: 10.3390/jcm12062217. PMID: 36983218; PMCID: PMC10053997.\u003c/li\u003e\n \u003cli\u003eMillington SJ, Koenig S. Ultrasound Assessment of the Inferior Vena Cava for Fluid Responsiveness: Making the Case for Skepticism. J Intensive Care Med. 2021;36(10):1223-1227. doi:10.1177/08850666211024176\u003c/li\u003e\n \u003cli\u003eKoratala A, Romero-Gonz\u0026aacute;lez G, Soliman-Aboumarie H, Kazory A. Unlocking the Potential of VExUS in Assessing Venous Congestion: The Art of Doing It Right. Cardiorenal Med. 2024;14(1):350-374. doi:10.1159/000539469\u003c/li\u003e\n \u003cli\u003eSiva B, Hunt A, Boudville N. The sensitivity and specificity of ultrasound estimation of central venous pressure using the internal jugular vein. J Crit Care. 2012;27(3):. doi:10.1016/j.jcrc.2011.09.008\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eChayapinun V, Koratala A, Assavapokee T. Seeing beneath the surface: Harnessing point-of-care ultrasound for internal jugular vein evaluation. World J Cardiol. 2024;16(2):73-79. doi:10.4330/wjc.v16.i2.73\u003c/li\u003e\n \u003cli\u003eHossein-Nejad H, Mohammadinejad P, Ahmadi F. Internal jugular vein/common carotid artery cross-sectional area ratio and central venous pressure. J Clin Ultrasound. 2016;44(5):312-318. doi:10.1002/jcu.22339\u003c/li\u003e\n \u003cli\u003ePrekker ME, Scott NL, Hart D, Sprenkle MD, Leatherman JW. Point-of-care ultrasound to estimate central venous pressure: a comparison of three techniques. Crit Care Med. 2013;41(3):833-841. doi:10.1097/CCM.0b013e31827466b\u003c/li\u003e\n \u003cli\u003eAmmirati E, Marchetti D, Colombo G, et al. Estimation of Right Atrial Pressure by Ultrasound-Assessed Jugular Vein Distensibility in Patients With Heart Failure. Circ Heart Fail. 2024;17(2):e010973. doi:10.1161/CIRCHEARTFAILURE.123.010973\u003c/li\u003e\n \u003cli\u003eVaidya GN, Kolodziej A, Stoner B, Galaviz JV, Cao X, Heier K, Thompson M, Birks E, Campbell K. Bedside ultrasound of the internal jugular vein to assess fluid status and right ventricular function: The POCUS-JVD study. Am J Emerg Med. 2023;70:151\u0026ndash;156. doi: 10.1016/j.ajem.2023.05.042\u003c/li\u003e\n \u003cli\u003eGuarracino F, Ferro B, Forfori F, Bertini P, Magliacano L, Pinsky MR. Jugular vein distensibility predicts fluid responsiveness in septic patients. Crit Care. 2014;18:647. doi: 10.1186/s13054-014-0647-1.\u003c/li\u003e\n \u003cli\u003eChaudhary R, Sukhi A, Simon MA, Villanueva FS, Pacella JJ. Role of Internal Jugular Venous Ultrasound in suspected or confirmed Heart Failure: A Systematic Review. J Card Fail. 2022;28(4):639-649. doi:10.1016/j.cardfail.2021.08.009\u003c/li\u003e\n \u003cli\u003eSekiguchi H, Seaburg LA, Suzuki J, et al. Central venous pressure and ultrasonographic measurement correlation and their associations with intradialytic adverse events in hospitalized patients: A prospective observational study. J Crit Care. 2018 Apr;44:168-174. doi:10.1016/j.jcrc.2017.10.039. Epub 2017 Oct 29. PubMed [citation] PMID:29132056 \u0026nbsp;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKerleroux B, Pasco J, Dupuis M, et al. Ultrasonographic assessment of the internal jugular vein for the estimation of central venous pressure in hemodialysis patients: A preliminary study. J Clin Ultrasound. 2018;46(4):253-258. doi:10.1002/jcu.22571\u003c/li\u003e\n \u003cli\u003eGawalkar AA, Batta A. Ultrasound based estimate of central venous pressure: Are we any closer?. \u003cem\u003eWorld J Cardiol\u003c/em\u003e. 2024;16(6):310-313. doi:10.4330/wjc.v16.i6.310\u003c/li\u003e\n \u003cli\u003eCanaud B, Kooman J, Selby NM, et al. Sodium and water handling during hemodialysis: new pathophysiologic insights and management approaches for improving outcomes in end-stage kidney disease. Kidney Int. 2019;95(2):296-309. doi:10.1016/j.kint.2018.09.024\u003c/li\u003e\n \u003cli\u003ePang CC. Autonomic control of the venous system in health and disease: effects of drugs. Pharmacol Ther. 2001;90(2-3):179-230. doi:10.1016/s0163-7258(01)00138-3\u003c/li\u003e\n \u003cli\u003ePellicori P, Shah P, Cuthbert J, et al. Prevalence, pattern and clinical relevance of ultrasound indices of congestion in outpatients with heart failure. Eur J Heart Fail. 2019;21(7):904-916. doi:10.1002/ejhf.1383\u003c/li\u003e\n \u003cli\u003ePellicori P, Kallvikbacka-Bennett A, Zhang J, et al. Revisiting a classical clinical sign: jugular venous ultrasound. Int J Cardiol. 2014;170(3):364-370. doi:10.1016/j.ijcard.2013.11.015\u003c/li\u003e\n \u003cli\u003eFatima S, Lambert W, Nouraie M, et al. Bedside ultrasound to assess acute central venous pressure change during treatment of decompensated heart failure. Int J Cardiol Heart Vasc. 2022 Jun 2;41:101067. doi: 10.1016/j.ijcha.2022.101067. PMID: 35676916; PMCID: PMC9168600.\u003c/li\u003e\n \u003cli\u003ePosada-Martinez EL, Cox ZL, Cano-Nieto MM, et al. Changes in the Inferior Vena Cava Are More Sensitive Than Venous Pressure During Fluid Removal: A Proof-ofConcept Study. J Card Fail. 2023;29(4):463-472. doi:10.1016/j.cardfail.2022.09.012\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9141317/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9141317/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAssessment of fluid status in patients receiving maintenance haemodialysis remains challenging. Point-of-care ultrasound (PoCUS) is increasingly used to support bedside evaluation of volume overload. The internal jugular vein (IJV) has been proposed as a potential marker of central venous pressure and systemic congestion. This pilot exploratory study aimed to investigate the feasibility and potential clinical utility of IJV ultrasound in patients undergoing maintenance haemodialysis.\u003c/p\u003e \u003cp\u003eWe conducted a prospective observational pilot exploratory study including CKD G5D patients undergoing maintenance haemodialysis. Patients with a history of jugular vein thrombosis, those receiving isovolemic dialysis treatments, and those unable to comply with the study protocol were excluded. Immediately before and after a scheduled haemodialysis session, patients underwent PoCUS examination of the internal jugular vein. Thirty-six ultrasonographic parameters were collected and analysed. Correlations between ultrasound parameters and fluid overload (delta from dry weight) were evaluated together with changes between pre- and post-dialysis examinations.\u003c/p\u003e \u003cp\u003eForty-nine patients were enrolled. IJV ultrasound measurements were not significantly influenced by several potential confounders including sex, body size, vascular access type, and the presence of heart failure. Several ultrasonographic parameters were significantly correlated with delta from dry weight. Among these, the Jugular Vein Distension (JVD) ratio showed the strongest association. Multiple parameters demonstrated significant changes between pre- and post-dialysis examinations.\u003c/p\u003e \u003cp\u003eIn this pilot exploratory study, IJV ultrasound appeared to be a feasible bedside tool for the assessment of fluid status in haemodialysis patients. Larger studies are needed to validate these findings and to determine the clinical utility of IJV-derived indices such as the JVD ratio.\u003c/p\u003e","manuscriptTitle":"Internal Jugular Vein Ultrasound for Fluid Status Assessment in Maintenance Haemodialysis: A Prospective Pilot Exploratory Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-07 07:24:55","doi":"10.21203/rs.3.rs-9141317/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-15T12:36:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-15T11:15:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-08T03:55:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"25277049410911141693230440878306160690","date":"2026-03-31T12:19:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212833589094603325550549637427047038443","date":"2026-03-31T12:03:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-31T11:29:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-31T11:25:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-20T11:41:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-18T18:20:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-03-18T11:27:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"adf11e12-828b-47a9-8556-d41e7d2b8e56","owner":[],"postedDate":"April 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":65619233,"name":"Health sciences/Diseases"},{"id":65619234,"name":"Health sciences/Health care"},{"id":65619235,"name":"Health sciences/Medical research"},{"id":65619236,"name":"Health sciences/Nephrology"}],"tags":[],"updatedAt":"2026-04-22T11:38:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-07 07:24:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9141317","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9141317","identity":"rs-9141317","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}