ArticleBMC nephrology2025
Venous Excess Doppler ultrasound assessment and loop diuretic efficiency in acute cardiorenal syndrome.
Article in BMC nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Kidney Failure in Cardiogenic Shock.Circulation. Heart failure · 2026Review
- Portal Vein Doppler Parameters as Indicators of Volume Status in Hemodialysis Patients Using Wireless Ultrasound.Cureus · 2026Article
- Rethinking Congestion in Heart Failure from Volume Overload to Venous Pressure and Organ Disfunction with VExUS.Medicina (Kaunas, Lithuania) · 2026Review
- Assessment of Congestion in Heart Failure Using VExUS: Current Evidence, Limitations and Clinical Perspectives.Life (Basel, Switzerland) · 2026Review
- A comprehensive review of venous excess ultrasound (VExUS) score: evidence from original research.Internal and emergency medicine · 2026Review
- Relationship between high VExUS score and echocardiographic parameters: a systematic review and meta-analysis.Journal of anesthesia, analgesia and critical care · 2026Review
- Extended venous excess ultrasound: A promising addition to point-of-care ultrasound-based venous congestion assessment.World journal of cardiology · 2026Review
- The rise of point-of-care ultrasound in cardiopulmonary diagnostics.European heart journal. Imaging methods and practice · 2026Review
- Association between venous excess ultrasound score and major adverse kidney events at 30 days in critically ill elderly patients: a multicenter prospective cohort study.Frontiers in medicine · 2026Article
- Ultrasound indicators of organ venous congestion: a narrative review.Annals of intensive care · 2025Review
- Intrarenal venous flow patterns and their association with successful fluid removal in critically ill patients: a prospective observational exploratory study.The ultrasound journal · 2025Article
- Diuretic resistance in cardiorenal syndrome: mechanisms, monitoring and phenotype-tailored management.Frontiers in cardiovascular medicine · 2025Review
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCardiorenal syndrome poses significant diagnostic and therapeutic challenges. The Venous Excess Ultrasound (VExUS) grading system based on the combination of venous Doppler assessments has shown potential in predicting acute kidney injury and cardiovascular outcomes, but its relevance regarding the management of acutely decompensated heart failure (ADHF) remains to be fully understood.
methodsIn this prospective study, patients with ADHF and acute kidney injury (AKI) were enrolled from a medical intensive care unit over 20 months. The study involved echocardiography and VExUS grading at admission and 72 h later. Data collection included clinical parameters, diuretic dosages, urine output, and fluid balance. Statistical analyses focused on exploring the relationships between VExUS grades and its components, including the renal venous stasis index (RVSI), diuretic efficiency, and renal function improvement.
resultsThe cohort of 43 patients showed varied VExUS grades at admission. Higher VExUS grades were significantly associated with lower diuretic efficiency. Specifically, the mean urine output per 40 mg of furosemide was 368 ± 213 mL, with patients having VExUS grade 2 or 3 exhibiting reduced diuretic efficiency compared to those with grade 0-1 (Grade 2 vs. Grade 0-1: 333 ± 214 mL vs. 507 ± 189 mL, p = 0.02; Grade 3 vs. Grade 0-1: 270 ± 167 mL vs. 507 ± 189 mL, p = 0.004). The relationship between VExUS grade and diuretic efficiency was independent of admission creatinine and prior use of loop-diuretics (β = -106 CI: -180; -32 p = 0.006). Among the components of venous congestion assessment, the RVSI had the best ability to predict low diuretic efficiency (AUROC: 0.76 (0.60; 091) p = 0.001). Improvement in VExUS grade at 72 h was correlated with significant renal function improvement (84.6% vs. 47.1% for improved vs. non-improved VExUS grades, p = 0.03).
conclusionHigh VExUS and RVSI grades at admission are independently associated with reduced diuretic efficiency in ADHF patients with AKI. The findings emphasize the clinical value of venous congestion assessment in cardiorenal syndrome management including the selection of an initial diuretic dose.
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