Target Weight Optimization based on a Modified VExUS Protocol in Hemodialysis: The VexHD Prospective Multi-Center Study
Year: 2026
Type: article
Study design: Clinical Trial
Abstract: INTRODUCTION: Clinical examination has limitations in estimating fluid overload in hemodialysis patients. The aim of the present study was to evaluate the impact of target weight optimization using a modified Venous Excess Ultrasonography Score (VExUS) protocol on blood pressure control in euvolemic hemodialysis patients. METHODS: We enrolled clinically euvolemic patients in hemodialysis from ten Spanish centers. Baseline clinical data, bioimpedance, and an extensive panel of cardiac, congestion, and inflammatory biomarkers were collected. Patients with congestion on modified VExUS protocol (excluding intrarenal vessels) underwent protocol-driven ultrafiltration adjustments. Blood pressure, bioimpedance, and biomarkers were reassessed at study completion, and paired statistical analyses were performed. RESULTS: Among the 72 clinically euvolemic patients included (60% male, mean age 69 ± 18 years), 23 (32%) showed venous congestion on modified VExUS protocol and entered the intervention group and 49 were followed under routine care conditions (reference). Volume values obtained by bioimpedance spectroscopy were similar in the congestion intervention and non-congestion reference groups. After 4 weeks, the intervention group experienced a significant improvement in modified VExUS protocol parameters compared to baseline (2.1 ± 0.5 vs. 1.3 ± 0.5; p < 0.001) and a systolic blood pressure reduction compared with reference group participants (-14 [-37; 4] vs. 4 [-9; 14] mm Hg) (p = 0.025). The reduction in systolic blood pressure was more notable in patients with higher baseline values. There were no differences in hemodialysis tolerance or biomarker changes between intervention and reference group participants. CONCLUSION: Modified VExUS protocol is a promising tool for evaluating volume overload and optimizing target weight. Its incorporation in the multiparametric assessment of target weight is associated with better blood pressure control.
Source: Cardiorenal Medicine
DOI: 10.1159/crm/abtag011
Authors: Patricia Muñoz Ramos, Alberto Ortiz, Ana B. Sanz, Martín Giorgi, Paloma Ruiz López-Alvarado, Irene Oñate, Verónica Ruth Mercado, José Carlos de La Flor Merino, Marco Vaca Gallardo, María Lina León-Machado, Virginia López de la Manzanara, Mohammad Manouchehri, Carlos Santos Alonso, Susana Carrasco, Miguel Ángel Navas Jiménez, Patricia de Sequera, Borja Quiroga, on behalf of the VExHD study collaborators group
Institutions: Hospital Universitario Infanta Leonor, Hospital Universitario de La Princesa, Hospital Universitario de Burgos, Hospital Universitario Infanta Sofía, Hospital Central de la Defensa Gómez Ulla, Hospital General Universitario Gregorio Marañón, Hospital Universitario Infanta Cristina, Hospital Clínico San Carlos, Hospital Universitario Príncipe de Asturias, Hospital General De Segovia
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
Awards: G1259844765, Promoviendo las defensas endógenas frente a la enfermedad renal, G2373695302, G2525722903, G2854544501, G2948614173, Multi-markers risk assessment of kidney sensitivity to injury to personalize prevention of acute kidney injury, G325810862, G4202917563, G4290602301, G4370900238, G511460989, G5309476972, G6604067511, Conservando la expresión de Klotho para retrasar el envejecimiento renal, G7596561613, Nuevos abordajes diagnósticos y terapéuticos para prevenir la muerte celular e inflamación activados por RIPK1 y RIPK3 en el fracaso renal agudo, G7797547491, G8185718001, G8644690310, G8868465937, G8981869668, G9000375569, Spain CKD cause (SPACKDc), G913512232, G998287453
OpenAlex ID: W7222304004