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ArticleThe ultrasound journal2025

Intrarenal venous flow patterns and their association with successful fluid removal in critically ill patients: a prospective observational exploratory study.

Chailat Maluangnon, Apatsara Saokaew, Satit Rojwatcharapibarn, Ranistha Ratanarat

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The ultrasound journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06216119 (Intrarenal Venous Flow Change During Fluid Removal in Critically Ill Patients), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06216119 completednot on this map

Intrarenal Venous Flow Change During Fluid Removal in Critically Ill Patients: A Prospective Exploratory Study

TypeobservationalSponsorMahidol UniversityRan2024 to 2024Enrolled52ConditionsCritical Illness, Fluid Overload
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Chailat MaluangnonDivision of Critical Care, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.ORCID http://orcid.org/0000-0002-2380-2255
Apatsara SaokaewDivision of Critical Care, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Satit RojwatcharapibarnDepartment of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.ORCID http://orcid.org/0000-0003-4079-9104
Ranistha RatanaratDivision of Critical Care, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. ranittha@hotmail.com.ORCID http://orcid.org/0000-0001-7137-5537

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDetermining the optimal timing for fluid removal in critically ill patients remains a challenge. This study evaluated the utility of Doppler ultrasound, specifically intrarenal venous flow (IRVF) patterns and venous excess ultrasound (VExUS) scores, and their associations with fluid removal outcomes, hemodynamic parameters, and clinical endpoints.

methodsIn this prospective observational exploratory study, 52 intensive care unit (ICU) patients who underwent fluid removal were enrolled. Baseline IRVF patterns and VExUS scores were assessed, with follow-up evaluations performed daily for three days. The primary outcome was to evaluate whether IRVF patterns were associated with successful fluid removal, defined as achieving a negative fluid balance for at least two consecutive days. Secondary outcomes included associations with central venous pressure (CVP), NT-proBNP, cumulative fluid balance, and clinical outcomes.

resultsThirty-one patients (59.6%) achieved successful fluid removal. A discontinuous baseline IRVF pattern was independently associated with successful fluid removal (adjusted odds ratio 4.31, 95% CI 1.02-18.18; P = 0.047). This pattern demonstrated high sensitivity of 87.1% (95% CI 70.2-96.4), moderate specificity of 42.9% (95% CI 21.8-66.0), and accuracy of 69.2% (95% CI 54.9-81.3). VExUS scores grades 2-3 demonstrated high specificity of 85.7% (95% CI 63.7-97.0) but low sensitivity of 29.0% (95% CI 14.2-48.0), with an accuracy of 51.9% (95% CI 37.6-66.0). An improvement in the IRVF pattern was significantly correlated with a reduction in NT-proBNP levels (P = 0.048). However, neither IRVF patterns nor VExUS scores improvements were associated with changes in fluid balance, CVP, or clinical outcomes such as 28-day mortality, ventilator-free days, or ICU length of stay.

conclusionsDiscontinuous IRVF patterns at baseline were significantly associated with fluid removal success, representing a physiologically based marker for deresuscitation readiness. More large-scale studies are warranted to validate these findings and explore long-term implications. Trial registration ClinicalTrials.gov identifier NCT06216119. Registered 22 January 2024, https://clinicaltrials.gov/study/NCT06216119.

Indexed as

De-escalationDoppler ultrasoundFluid removalIntensive care unitIntrarenal venous flowVenous excess ultrasound

Identifiers

PMID41051454
PMCPMC12501087

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.