Point-of-Care Ultrasonography (POCUS)-Driven Strategy to Improve Hypertension in Hemodialysis: A Quality Improvement Project
Bibliographic record
Abstract
Background: Hypertension is a common cardiovascular risk factor in hemodialysis (HD) patients, often due to volume overload. Traditional clinical assessments of volume status are limited. Point-of-care ultrasound (PoCUS), including lung, IVC, and Venous Excess Ultrasound (VeXUS) offer more objective and reproducible evaluation. Incorporating PoCUS may enable precise dry weight management and improve blood pressure (BP) control. Methods: Reduce the proportion of patients with uncontrolled hypertension by 60% on a single dialysis shift—without increasing adverse events—using a PoCUS-guided volume management strategy at a teaching hospital in Toronto, Canada. A pre-intervention chart review in January 2025 found that 22% of patients on an evening shift had uncontrolled hypertension (SBP >140 mmHg on ≥2 antihypertensives). The intervention included biweekly comprehensive PoCUS scans by a trained physician, with formal documentation and dry weight recommendations for dialysis staff. The primary outcome was change in mid-week intradialytic BP. Process measures included scan counts and uptake of PoCUS recommendations. Balancing measures tracked intradialytic hypotension, cramping, added ultrafiltration sessions, and hospitalizations for volume-related complications. Results: Five patients (mean age 54.2 years, 80% male) were monitored over two scanning cycles (January and April 2025), with 16 PoCUS scans completed (Fig 1). BP improved in 60% of patients following the intervention. PoCUS findings differed from clinical volume assessments in 31% of cases; 60% of these led to changes in management. Two patients reported cramping—one found to be volume depleted on PoCUS. No intradialytic hypotension, hospitalizations, or additional ultrafiltration sessions occurred. Conclusion: Routine PoCUS-guided assessments may improve BP control in HD patients by informing volume management. This pilot highlights its potential as a clinical exam adjunct, warranting further study to assess long-term benefits.Median mid-week SBP (mm Hg) of 5 HD patients with uncontrolled hypertension on days of PoCUS assessments.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.028 | 0.024 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.003 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".