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González-Seguel F, Tran VQ, Pal CA, Shareef ZT, Israel HP, Horikawa-Strakovsky A, Wen Y, Griffin BR, Neyra JA, Teixeira JP, Mayer KP. Inter-rater reliability of muscle ultrasonography performed by multidisciplinary novice sonographers in the evaluation of critically ill patients with acute kidney injury requiring continuous kidney replacement therapy. Ren Fail 2025; 47:2472990. [PMID: 40069097 PMCID: PMC11899198 DOI: 10.1080/0886022x.2025.2472990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Revised: 02/20/2025] [Accepted: 02/22/2025] [Indexed: 03/14/2025] Open
Abstract
Early diagnosis of muscle wasting in critically ill patients with acute kidney injury requiring continuous kidney replacement therapy (AKI-CKRT) may improve outcomes via timely rehabilitation and nutrition. Muscle ultrasound (MUS) has recently gained traction for assessing muscle atrophy in the intensive care unit (ICU) but requires training to achieve reproducibility. We evaluated the inter-rater reliability of MUS in patients with AKI-CKRT performed by multidisciplinary raters including nephrologists. Two blinded independent raters used portable ultrasound to acquire images of the rectus femoris (RF). All raters were clinicians routinely caring for patients with CKRT in the ICU and were initially novices in MUS. They underwent three two-hour teleconference training sessions in MUS led by an experienced physiotherapist. Inter-rater reliability was evaluated with intraclass correlation coefficients (ICCs) [95% confidence interval] using a two-way random-effects model. We analyzed 54 MUS images (27 pairs) from nine patients at baseline (n = 16), day 3 (n = 6), day 7 (n = 8), ICU discharge (n = 10), hospital discharge (n = 10), and 1-3 months after discharge (n = 4). The mean (±standard deviation) values of RF thickness, cross-sectional area, and echointensity were 1.7 ± 1.4 cm, 4.6 ± 2.7 cm2, and 84.0 ± 17.7 AU, respectively. Reliability was excellent for RF thickness (ICC = 0.96 [0.91-0.98], p < 0.001) and cross-sectional area (ICC = 0.92 [0.83-0.96], p < 0.001) but poor for echointensity (ICC = 0.41 [0.04-0.68], p < 0.05). These results demonstrate reliable assessment of muscle size in patients with AKI-CKRT using ultrasound performed by multidisciplinary novice sonographers trained via teleconference, suggesting that this methodology may be useful in future studies of muscle wasting in patients with AKI-CKRT.
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Affiliation(s)
- Felipe González-Seguel
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, USA
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
| | - Vinh Q. Tran
- Division of Physical Therapy, Department of Orthopaedics, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Chaitanya Anil Pal
- Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Zan T. Shareef
- Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Hayley P. Israel
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Arimitsu Horikawa-Strakovsky
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
- Math, Science, and Technology Center Program, Paul Laurence Dunbar High School, Lexington, KY, USA
- Institute for Biomedical Informatics, University of Kentucky, Lexington, KY, USA
| | - Yuan Wen
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
- Institute for Biomedical Informatics, University of Kentucky, Lexington, KY, USA
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Benjamin R. Griffin
- Division of Nephrology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Javier A. Neyra
- Department of Internal Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J. Pedro Teixeira
- Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, NM, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Kirby P. Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY, USA
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
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Koratala A, Kazory A. POCUS in Nephrology: Enthusiasm Alone Won't Suffice; Training Is Key. Am J Kidney Dis 2025:S0272-6386(25)00767-X. [PMID: 40107644 DOI: 10.1053/j.ajkd.2025.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 01/08/2025] [Accepted: 01/17/2025] [Indexed: 03/22/2025]
Abstract
Point-of-care ultrasonography (POCUS) allows for real-time bedside imaging and interpretation, enhancing clinical decision-making by addressing focused clinical questions. Historically confined to procedural guidance in nephrology, POCUS is gaining traction for broader diagnostic applications, including comprehensive hemodynamic assessment. This narrative review examines the expanding role of POCUS in nephrology, highlighting its potential to improve patient care and streamline diagnostics while acknowledging associated risks. Improper or untrained use of POCUS can result in patient harm and diagnostic errors, underscoring the need for rigorous training and standardized competency requirements akin to board certification. We advocate for collaboration among nephrology societies to establish universal training frameworks and certification processes. Key elements for successful POCUS integration include learner motivation, structured longitudinal programs, and expert oversight. Additionally, proper understanding and investigator proficiency in POCUS enhance the quality of research output, further advancing the field. By fostering these principles, the nephrology community can maximize POCUS utility, ensuring its safe and effective application in clinical practice while addressing patient care gaps.
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Affiliation(s)
| | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida, USA
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Sinanan R, Moshtaghi A, Koratala A. Point-of-care ultrasound in nephrology: A private practice viewpoint. World J Methodol 2024; 14:95685. [PMID: 39712563 PMCID: PMC11287536 DOI: 10.5662/wjm.v14.i4.95685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/28/2024] [Accepted: 07/05/2024] [Indexed: 07/26/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is a limited ultrasound examination performed by the clinician at the bedside, emerging as a complement to physical examination across various medical specialties. In the field of nephrology, its integration has been gradual, primarily limited to guiding procedures like temporary dialysis catheter placement or, in some cases, diagnostic kidney ultrasounds. In reality, the assessment of hemodynamic status at the bedside holds immense value for nephrologists, yet there exists limited awareness among practitioners regarding its implementation. While there is a growing trend towards incorporating multi-organ POCUS training in fellowship programs, private practice nephrologists remain relatively uninformed. This discussion explores the untapped potential of POCUS as a valuable diagnostic tool in everyday nephrology practice, demonstrating its effectiveness in diverse clinical settings, ranging from medical wards to outpatient dialysis units. Additionally, we delve into the challenges hindering its widespread adoption and consider the future trajectory of this innovative approach.
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Affiliation(s)
- Rajiv Sinanan
- Arizona Kidney Disease and Hypertension Centers, Phoenix, AZ 85016, United States
| | - Afsheen Moshtaghi
- Department of Medicine, Verde Valley Medical Center, Cottonwood, AZ 86326, United States
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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Koratala A, Argaiz ER, Romero-González G, Reisinger N, Anwar S, Beaubien-Souligny W, Bhasin-Chhabra B, Diniz H, Vaca Gallardo M, Graterol Torres F, Husain-Syed F, Hanko J, Jaberi A, Kazory A, Raina R, Ronco C, Salgado OJ, Sethi SK, Villavicencio-Cerón V, Yadla M, Bastos MG. Point-of-care ultrasound training in nephrology: a position statement by the International Alliance for POCUS in Nephrology. Clin Kidney J 2024; 17:sfae245. [PMID: 39502372 PMCID: PMC11536759 DOI: 10.1093/ckj/sfae245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Indexed: 11/08/2024] Open
Abstract
Point-of-care ultrasonography (POCUS) has rapidly evolved from a niche technology to an indispensable tool across medical specialties, including nephrology. This evolution is driven by advancements in technology and the visionary efforts of clinicians in emergency medicine and beyond. Recognizing its potential, medical schools are increasingly integrating POCUS into training curricula, emphasizing its role in enhancing diagnostic accuracy and patient care. Despite these advancements, barriers such as limited faculty expertise and 'lack of' standardized guidelines hinder widespread adoption and regulation. The International Alliance for POCUS in Nephrology (IAPN), through this position statement, aims to guide nephrologists in harnessing the diagnostic power of POCUS responsibly and effectively. By outlining core competencies, recommending training modalities and advocating for robust quality assurance measures, we envision a future where POCUS enhances nephrology practice globally, ensuring optimal patient outcomes through informed, evidence-based decision-making. International collaboration and education are essential to overcome current challenges and realize the full potential of POCUS in nephrology and beyond.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Eduardo R Argaiz
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Gregorio Romero-González
- Nephrology Department, Germans Trias i Pujol University Hospital, Barcelona, Spain
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute, Barcelona, Spain
- International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Nathaniel Reisinger
- Renal Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Siddiq Anwar
- Division of Medicine, Sheikh Shakhbout Medical City and School of Medicine Khalifa University, Abu Dhabi, United Arab Emirates
- ADIA Lab, Abu Dhabi, United Arab Emirates
| | | | | | - Hugo Diniz
- Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Marco Vaca Gallardo
- Nephrology Department, Hospital General Universitario Gregorio Marañón Madrid, Spain
| | - Fredzzia Graterol Torres
- Extracorporeal Therapies Unit. Germans Trias i Pujol University Hospital. Badalona, Spain
- REMAR-IGTP Group (Kidney-Affecting Diseases Research Group), Germans Trias i Pujol Research Institute, Barcelona, Spain
| | - Faeq Husain-Syed
- Department of Internal Medicine II, Division of Nephrology, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany
| | - Jennifer Hanko
- Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Aala Jaberi
- Renal Section, Boston University Medical Center, Boston, MA, USA
| | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL, USA
| | - Rupesh Raina
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
- Department of Nephrology, Akron Children's Hospital, Akron, OH, USA
| | - Claudio Ronco
- International Renal Research Institute and IRRIV Foundation for Research in Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Octavio J Salgado
- Department of Nephrology, School of Medicine, Universidad Católica de Cuenca, Avenida Las Américas y Humbolt, Cuenca, Ecuador
| | - Sidharth Kumar Sethi
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, India
| | - Vanessa Villavicencio-Cerón
- Department of Nephrology of the IEES Hospital, Portomed (Integral Center of Specialties), Portoviejo, Ecuador
| | - Manjusha Yadla
- Department of Nephrology, Gandhi Medical College, Gandhi Hospitals, Hyderabad, Telangana, India
| | - Marcus Gomes Bastos
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora, Juiz de Fora, MG, Brazil
- Faculdade Ubaense Ozanam Coelho, Ubá, MG, Brazil
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Broadstock AT, Baez J, Minges PG, Frederick M, Stolz LA. Directed image review technique (DIRT): A framework for ultrasound image assessment and interpretation. AEM EDUCATION AND TRAINING 2024; 8:e11036. [PMID: 39439543 PMCID: PMC11494445 DOI: 10.1002/aet2.11036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/30/2024] [Accepted: 10/01/2024] [Indexed: 10/25/2024]
Abstract
Use of point-of-care ultrasound (POCUS) is integral to the practice of emergency medicine, and POCUS education is a required component of emergency medicine training. Developing POCUS skills requires iterative deliberate practice of image acquisition and interpretation. Providing feedback to learners regarding ultrasound image interpretation can be challenging for emergency medicine clinician educators. We present a framework called the directed image review technique. This framework guides learner ultrasound image interpretation and provides educators with a similar structured approach to evaluate a learner's ultrasound competency and provide targeted feedback regarding image acquisition and interpretation.
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Koratala A, Regner KR. Letter to the Editor: Point-of-care ultrasound in cirrhosis-related acute kidney injury: A cautionary note. Liver Transpl 2024; 30:E38-E39. [PMID: 38899942 DOI: 10.1097/lvt.0000000000000411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 06/21/2024]
Affiliation(s)
- Abhilash Koratala
- Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Bhasin-Chhabra B, Koratala A. Pulse of Prudence: Navigating Isolated Lung Ultrasound in Patients Receiving Hemodialysis. Kidney Med 2024; 6:100862. [PMID: 39139594 PMCID: PMC11320598 DOI: 10.1016/j.xkme.2024.100862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
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Premkumar M, Karvellas CJ, Kulkarni AV, Bhujade H, Reddy KR. Role of point-of-care ultrasound (POCUS) in clinical hepatology. Hepatology 2024:01515467-990000000-00946. [PMID: 38954829 DOI: 10.1097/hep.0000000000000990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/13/2024] [Indexed: 07/04/2024]
Abstract
Hospitalized patients with cirrhosis frequently require critical care management for sepsis, HE, respiratory failure, acute variceal bleeding, acute kidney injury (AKI), shock, and optimization for liver transplantation, while outpatients have unique care considerations. Point-of-care ultrasonography (POCUS) enhances bedside examination of the hepatobiliary system and relevant extrahepatic sites. POCUS includes cardiac US and is used to assess volume status and hemodynamic parameters like cardiac output, systemic vascular resistance, cardiac contractility, and pulmonary artery pressure, which aid in the early and accurate diagnosis of heart failure, cirrhotic cardiomyopathy, porto-pulmonary hypertension, hepatopulmonary syndrome, arrhythmia, and pulmonary embolism. This also helps in fluid management and vasopressor use in the resuscitation of patients with cirrhosis. Lung ultrasound (LUS) can help in differentiating pneumonia, effusion, and edema. Further, US guides interventions such as line placement, drainage of abdominal collections/abscesses, relief of tension pneumothorax, drainage of pleural and pericardial effusions, and biliary drainage in cholangitis. Additionally, its role is essential to assess liver masses foci of sepsis, for appropriate sites for paracentesis, and to assess for vascular disorders such as portal vein or hepatic vein thrombosis. Renal US can identify renal and postrenal causes of AKI and aid in diagnosis of prerenal AKI through volume assessment. In this review, we address the principles and methods of POCUS in hospitalized patients and in outpatients with cirrhosis and discuss the application of this diverse modality in clinical hepatology.
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Affiliation(s)
- Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Constantine J Karvellas
- Department of Critical Care Medicine, Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada
| | - Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Interventional Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, USA
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Sethi SK, Mahan J, Hu J, Koratala A, Soni K, Singh Y, Abitbol C, DeFreitas M, Reisinger N, Argaiz ER, Yap HK, Badeli H, Kalra M, VanGeest J, Nair N, Raynor J, Alhasan KA, McCulloch M, Bunchman T, Sharma V, Raina R. Point-of-Care Ultrasound (POCUS) Training Curriculum for Pediatric Nephrology: PCRRT-ICONIC Group Recommendations. KIDNEY360 2024; 5:671-680. [PMID: 38477662 PMCID: PMC11146640 DOI: 10.34067/kid.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/06/2024] [Indexed: 03/14/2024]
Abstract
Key Points Despite a high need and interest in point-of-care ultrasound (POCUS) in trainees and faculty of Pediatric Nephrology, the majority are not receiving POCUS training. There is a need to establish a structured pediatric nephrology POCUS program for clinicians and fellows. This study suggests a blueprint of POCUS curriculum which can serve as a foundation for POCUS education in pediatric nephrology centers worldwide. Background Point-of-care ultrasound (POCUS) is commonly used in adult specialties, pediatric emergency medicine, and neonatal and pediatric critical care. Specifically, in the field of pediatric nephrology, POCUS plays a valuable role in the critical inpatient and outpatient settings. However, the lack of guidelines and a standardized curriculum for POCUS in pediatric nephrology has led to substantial discrepancies in both clinical practice and training. Methods A multinational, multicenter survey regarding POCUS usefulness and training was sent to 225 pediatric nephrology residents, fellows, and physicians with expertise in pediatric nephrology. On the basis of the results, an ideal pediatric nephrology POCUS curriculum was formulated with a panel of experts from across the world. Eighteen experts were included, with each expert having >10 years of experience in using POCUS in adult and pediatric nephrology. A Delphi method was used to further solidify guidelines regarding the content, curriculum, and vital skills of using POCUS in pediatric nephrology. Results A total of 134 pediatric nephrology trainees, specialists, and faculty responded to the survey (59.6% completion rate). A total of 87.4% of respondents believe that formal POCUS training is either highly desirable or should be mandatory in pediatric nephrology fellowship programs. Identified barriers to receiving training included lack of an organized curriculum, lack of POCUS experts and pediatric intensivists, lack of ultrasound equipment, lack of financial support, and lack of dedicated time during training. An expert panel was convened, and a Delphi survey was conducted to formulate guidelines to overcome the barriers to pediatric nephrology POCUS and standardize the training process. Conclusions After collaborating with prominent pediatric nephrologists, global POCUS experts proposed a comprehensive POCUS training curriculum tailored specifically for pediatric nephrology trainees, with an appeal for all pediatric nephrology education programs to integrate POCUS instruction into their curricula.
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Affiliation(s)
| | - John Mahan
- Pediatric Nephrology, Nationwide Children's Hospital/The Ohio State University, Columbus, Ohio
| | - Jieji Hu
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kritika Soni
- Pediatric Nephrology, Medanta, The Medicity, Gurgaon, India
| | - Yogen Singh
- Division of Neonatology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California
| | - Carolyn Abitbol
- Division of Nephrology, Department of Pediatrics, University of Miami/Holtz Children's Hospital, Miami, Florida
| | - Marissa DeFreitas
- Division of Nephrology, Department of Pediatrics, University of Miami/Holtz Children's Hospital, Miami, Florida
| | - Nathaniel Reisinger
- Division of Renal Electrolyte and Hypertension, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eduardo R. Argaiz
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey, Mexico
| | - Hui Kim Yap
- Children's Kidney Centre, Khoo Teck Puat – National University Children's Medical Institute, Singapore
| | - Hamidreza Badeli
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Meenal Kalra
- Department of Paediatrics, Kasturba Medical College, Manipal, India
| | | | - Nikhil Nair
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - James Raynor
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Khalid A. Alhasan
- Pediatric Nephrology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mignon McCulloch
- Department of Paediatric Nephrology and Transplantation, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Timothy Bunchman
- Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Vivek Sharma
- Department of Imaging and Radiology, Medanta, The Medicity, Gurgaon, India
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Koratala A, Soni NJ, Mehta R, Reisinger N. Effectiveness of a Brief Point of Care Ultrasound Course at a National Nephrology Conference. POCUS JOURNAL 2024; 9:71-74. [PMID: 38681161 PMCID: PMC11044936 DOI: 10.24908/pocus.v9i1.16858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
The rising demand for point of care ultrasound (POCUS) instruction during nephrology fellowship has been limited due to a shortage of trained faculty and courses designed specifically for nephrologists. A hands-on POCUS pre-course was organized during the April 2023 National Kidney Foundation (NKF) Spring Clinical Meeting to address this challenge. The course consisted of pre-recorded lectures and a 4-hour hands-on workshop guided by multidisciplinary POCUS experts. The anonymous post-course survey received responses from 25 out of 39 participants, yielding a 64.1% response rate. On a scale of 0-10, confidence levels for acquiring kidney images rose from 2.6 + 2.3 (mean + SD) pre-workshop to 7.8 + 1.5 post-workshop (p<0.001). Similarly, a remarkable improvement in confidence for acquiring lung and cardiac images was seen as scores increased from 1.8 + 2.4 to 7.7 + 1.5 (p<0.001) and from 1.5 + 2.2 to 7.2 + 1.3 (p<0.001), respectively. Additionally, respondents reported a substantial improvement in their confidence to interpret kidney, lung, and cardiac POCUS images, with scores increasing from 4.5 + 2.2 to 7.7 + 1.1 (p<0.001), 2.3 + 2.4 to 7.6 + 1.5 (p<0.001), and 2 + 2 to 7.3 + 1.5 (p<0.001), respectively. Barriers to implementing POCUS use at institutions included a perceived lack of trained faculty, limited protected time for faculty, and insufficient support from division leadership. The NKF POCUS pre-course successfully improved participants' confidence in acquiring and interpreting basic POCUS images.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of WisconsinMilwaukee, WIUSA
| | - Nilam J Soni
- Department of Medicine, University of Texas Health San AntonioSan Antonio, TXUSA
| | - Rupal Mehta
- Division of Nephrology, Department of Medicine, Northwestern UniversityChicago, ILUSA
| | - Nathaniel Reisinger
- Renal Electrolyte and Hypertension Division, University of PennsylvaniaPhiladelphia, PAUSA
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Kazory A, Olaoye OA, Koratala A. Nuances of Point-of-Care Ultrasound in Nephrology: A Clarion Call for Deeper Understanding. Blood Purif 2024; 53:598-602. [PMID: 38621364 DOI: 10.1159/000538909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024]
Affiliation(s)
- Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida, USA
| | - Olanrewaju A Olaoye
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida, USA
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Romero-González G, Argaiz ER, Koratala A, González DA, Vives M, Juega J, Soler-Majoral J, Graterol F, Perezpayá I, Rodriguez-Chitiva N, Lorenzo-Ferris I, Narvaez C, Manrique J, Morales E, Rivera-Gorrín M, Ibeas J, Bover J, Sánchez E, de Sequera P. Towards standardization of POCUS training in Nephrology: the time is NOW. Nefrologia 2024; 44:5-9. [PMID: 38429147 DOI: 10.1016/j.nefroe.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 03/03/2024] Open
Affiliation(s)
- Gregorio Romero-González
- Servicio de Nefrología, Hospital Germans Trias i Pujol, Grupo REMAR-IGTP, Instituto de Investigación Germans Trias i Pujol (IGTP), Badalona, Spain; International Renal Research Institute of Vicenza, Vicenza, Italy.
| | - Eduardo R Argaiz
- Servicio de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Spain
| | - Abhilash Koratala
- División de Nefrología, Medical College of Wisconsin, Milwaukee, USA
| | - Duilio Ariel González
- Miembro del Grupo de la Red Española de Ecografía en Cuidado Crítico. Servicio de Anestesiología y Reanimación, Clínica Universidad de Navarra, Pamplona, Spain
| | - Marc Vives
- Copresidente del Grupo de la Red Española de Ecografía en Cuidado Crítico, Servicio de Anestesiología y Reanimación, Clínica Universidad de Navarra, Profesor Asociado, Facultad de Medicina, Universidad de Navarra, Pamplona, Spain
| | - Javier Juega
- Servicio de Nefrología, Hospital Germans Trias i Pujol, Grupo REMAR-IGTP, Instituto de Investigación Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Jordi Soler-Majoral
- Servicio de Nefrología, Hospital Germans Trias i Pujol, Grupo REMAR-IGTP, Instituto de Investigación Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Fredzzia Graterol
- Servicio de Nefrología, Hospital Germans Trias i Pujol, Grupo REMAR-IGTP, Instituto de Investigación Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Inés Perezpayá
- Servicio de Nefrología, Hospital Germans Trias i Pujol, Grupo REMAR-IGTP, Instituto de Investigación Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Néstor Rodriguez-Chitiva
- Servicio de Nefrología, Hospital Germans Trias i Pujol, Grupo REMAR-IGTP, Instituto de Investigación Germans Trias i Pujol (IGTP), Badalona, Spain
| | | | - Carlos Narvaez
- Servicio de Nefrología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Joaquín Manrique
- Servicio de Nefrología, Hospital Universitario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Enrique Morales
- Servicio de Nefrología, Hospital 12 de Octubre, Madrid, Spain
| | - Maite Rivera-Gorrín
- Servicio de Nefrología, Hospital Universitario Ramón y Cajal. IRyCis. UAH, Madrid, Spain; Coordinadora del Grupo de Nefrología Diagnóstica e Intervencionista de la Sociedad Española de Nefrología, Spain
| | - José Ibeas
- Servicio de Nefrología, Parc Taulí Hospital Universitari, Institut d´investigació i innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Jordi Bover
- Servicio de Nefrología, Hospital Germans Trias i Pujol, Grupo REMAR-IGTP, Instituto de Investigación Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Emilio Sánchez
- Servicio de Nefrología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Patricia de Sequera
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain
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Koratala A, Reisinger N. Point-of-Care Ultrasound Training in Nephrology: A Leap Forward, Not Merely a Check Mark. Kidney Med 2024; 6:100752. [PMID: 38188457 PMCID: PMC10770553 DOI: 10.1016/j.xkme.2023.100752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nathaniel Reisinger
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, Pennsylvania
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Koratala A, Kazory A. Seeing through the myths: Practical aspects of diagnostic point-of-care ultrasound in nephrology. World J Nephrol 2023; 12:112-119. [PMID: 38230300 PMCID: PMC10789085 DOI: 10.5527/wjn.v12.i5.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 12/22/2023] Open
Abstract
Point of care ultrasonography (POCUS) is emerging as an invaluable tool for guiding patient care at the bedside, providing real-time diagnostic information to clinicians. Today, POCUS is recognized as the fifth pillar of bedside clinical examination, alongside inspection, palpation, percussion, and auscultation. In spite of growing interest, the adoption of diagnostic POCUS in nephrology remains limited, and comprehensive training beyond kidney ultrasound is offered in only a few fellowship programs. Moreover, several misconceptions and barriers surround the integration of POCUS into day-to-day nephrology practice. These include myths about its scope, utility, impact on patient outcomes and legal implications. In this minireview, we address some of these issues to encourage wider and proper utilization of POCUS.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Wauwatosa, WI 53226, United States
| | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL 32610, United States
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15
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Koratala A, Paudel HR, Regner KR. Nephrologist-Led Simulation-Based Focused Cardiac Ultrasound Workshop for Medical Students: Insights and Implications. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 10:100051. [PMID: 39035249 PMCID: PMC11256268 DOI: 10.1016/j.ajmo.2023.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/03/2023] [Accepted: 07/07/2023] [Indexed: 07/23/2024]
Abstract
Background Point-of-care ultrasonography (POCUS) is being increasingly recognized as an adjunct to physical examination. However, limited availability of trained faculty in specialties other than emergency medicine and lack of universal training standards remain key barriers to its widespread integration into undergraduate and graduate medical curricula. In this study, we sought to explore the effectiveness of a short simulation-based workshop for medical students teaching basic cardiac ultrasound led by a nephrologist. Methods Workshops were conducted for 2 different groups of 4th-year medical students with a total of 25 attendees. The workshop consisted of a 1-hour lecture followed by 15 minutes of cardiac anatomy simulation and a 2- to 2.5-hour hands-on session in the simulation laboratory. An anonymous precourse questionnaire comprising 10 questions assessing the interpretation of common grayscale ultrasound findings encountered in patients with undifferentiated hypotension was performed. After the workshop, a postcourse exam and survey were conducted, retesting the same concepts and seeking the students' feedback on the course. Results In total, 23 and 20 students answered the pre- and postcourse surveys, respectively. The mean total score on the pretest was 63.8% ± 13.6%, which significantly increased to 91.5% ± 10.5% on the posttest (P < .001). About 90% of the respondents strongly agreed that the cardiac anatomy simulation improved their understanding of the cardiac sonographic anatomy; 75% strongly agreed that the hands-on simulation enhanced their confidence in image acquisition and interpretation; and 70% said they would choose nephrology elective if POCUS training was integrated with it. Conclusions A nephrologist-led diagnostic POCUS workshop using simulation techniques is effective in improving the learners' knowledge, understanding of the sonographic cardiac anatomy, and confidence in image acquisition. Integration of POCUS training may increase medical student interest in nephrology elective rotations.
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Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Hari R. Paudel
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kevin R. Regner
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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16
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Batool A, Koratala A. Aortocaval fistula on point-of-care ultrasound: a potential cause of high-output cardiac failure. Intern Emerg Med 2023; 18:2135-2137. [PMID: 37195593 DOI: 10.1007/s11739-023-03304-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/08/2023] [Indexed: 05/18/2023]
Affiliation(s)
- Aisha Batool
- Division of Nephrology, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA.
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA
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17
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Batool A, Chaudhry S, Koratala A. Transcending boundaries: Unleashing the potential of multi-organ point-of-care ultrasound in acute kidney injury. World J Nephrol 2023; 12:93-103. [PMID: 37766842 PMCID: PMC10520752 DOI: 10.5527/wjn.v12.i4.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/24/2023] [Accepted: 09/11/2023] [Indexed: 09/20/2023] Open
Abstract
Acute kidney injury (AKI) is a clinical syndrome characterized by a rapid increase in serum creatinine levels or a decrease in urine output or both. In spite of thorough history-taking, physical examination, and laboratory analysis, there are limitations in the diagnostic process and clinical monitoring of AKI. Point-of-care ultrasonography (POCUS), a limited ultrasound study performed by clinicians at the bedside, has emerged as a valuable tool in different clinical settings. In this discussion, we explore the potential of POCUS performed by nephrologists to address specific questions encountered in the diagnosis and management of AKI patients. POCUS not only aids in excluding hydronephrosis but also provides real-time insights into hemodynamics, enabling formulation of individualized treatment plans. Further studies are required to assess the impact of multi-organ POCUS on pragmatic patient outcomes related to AKI, as well as its potential in risk stratification and identification of different levels of AKI severity and pathophysiological signatures.
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Affiliation(s)
- Aisha Batool
- Department of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
| | - Shahzad Chaudhry
- Department of Family Medicine, Advocate Aurora Healthcare, Milwaukee, WI 53202, United States
| | - Abhilash Koratala
- Department of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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18
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Rosenberg ME, Anderson S, Farouk SS, Gibson KL, Hoover RS, Humphreys BD, Orlowski JM, Udani SM, Waitzman JS, West M, Ibrahim T. Reimagining Nephrology Fellowship Education to Meet the Future Needs of Nephrology: A Report of the American Society of Nephrology Task Force on the Future of Nephrology. Clin J Am Soc Nephrol 2023; 18:816-825. [PMID: 36848491 PMCID: PMC10278777 DOI: 10.2215/cjn.0000000000000133] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 03/01/2023]
Abstract
The American Society of Nephrology (ASN) Task Force on the Future of Nephrology was established in April 2022 in response to requests from the American Board of Internal Medicine and the Accreditation Council for Graduate Medical Education regarding training requirements in nephrology. Given recent changes in kidney care, ASN also charged the task force with reconsidering all aspects of the specialty's future to ensure that nephrologists are prepared to provide high-quality care for people with kidney diseases. The task force engaged multiple stakeholders to develop 10 recommendations focused on strategies needed to promote: ( 1 ) just, equitable, and high-quality care for people living with kidney diseases; ( 2 ) the value of nephrology as a specialty to nephrologists, the future nephrology workforce, the health care system, the public, and government; and ( 3 ) innovation and personalization of nephrology education across the scope of medical training. This report reviews the process, rationale, and details (the "why" and the "what") of these recommendations. In the future, ASN will summarize the "how" of implementing the final report and its 10 recommendations.
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Affiliation(s)
| | | | | | - Keisha L. Gibson
- University of North Carolina Kidney Center, Raleigh, North Carolina
| | | | | | | | - Suneel M. Udani
- Nephrology Associates of Northern Illinois and Indiana (NANI), Chicago, Illinois
| | | | | | - Tod Ibrahim
- American Society of Nephrology, Washington, DC
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19
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Cook DL, Patel S, Nee R, Little DJ, Cohen SD, Yuan CM. Point-of-Care Ultrasound Use in Nephrology: A Survey of Nephrology Program Directors, Fellows, and Fellowship Graduates. Kidney Med 2023; 5:100601. [PMID: 36941846 PMCID: PMC10024220 DOI: 10.1016/j.xkme.2023.100601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Rationale & Objective Adoption of point-of-care ultrasound (POCUS) into nephrology practice has been relatively slow. We surveyed US nephrology program directors, their fellows, and graduates from a single training program regarding current/planned POCUS training, clinical use, and barriers to training and use. Study Design Anonymous, online survey. Setting & Participants All US nephrology program directors (n=151), their fellows (academic year 2021-2022), and 89/90 graduates (1980-2021) of the Walter Reed Nephrology Program. Analytical Approach Descriptive. Results 46% (69/151) of program directors and 33% (118/361) of their fellows responded. Response rate was 62% (55/89) for Walter Reed graduates. 51% of program directors offered POCUS training, most commonly bedside training in non-POCUS oriented rotations (71%), didactic lectures (68%), and simulation (43%). 46% of fellows reported receiving POCUS training, but of these, many reported not being sufficiently trained/not confident in kidney (56%), bladder (50%), and inferior vena cava assessment (46%). Common barriers to training reported by program directors were not enough trained faculty (78%), themselves not being sufficiently trained (55%), and equipment expense (51%). 64% of program directors and 55% of fellows reported <10% of faculty were able to perform POCUS. 64% of fellows reported having too little POCUS training. 72% of program directors and 77% of graduates felt POCUS should be incorporated into the fellowship curriculum. 59% of fellows and 61% of graduates desired hands-on POCUS training rather than didactic lectures or simulation. Limitations Loss of respondents as program directors and fellows progressed through the survey. Conclusions Nephrology program directors, fellows, and graduates surveyed want POCUS training incorporated into the fellowship curriculum. No group felt sufficiently trained to confidently perform POCUS, and the major barrier to training was lack of sufficiently trained faculty. This highlights the need to "train the trainers" before POCUS can be fully integrated into fellowship training and regularly used in nephrology practice.
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Affiliation(s)
- David L. Cook
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Samir Patel
- Washington DC VA Medical Center, Washington, District of Columbia
| | - Robert Nee
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Dustin J. Little
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Scott D. Cohen
- Washington DC VA Medical Center, Washington, District of Columbia
| | - Christina M. Yuan
- Walter Reed National Military Medical Center, Bethesda, Maryland
- Address for Correspondence: Christina M. Yuan, MD, Nephrology SVC, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD 20889.
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20
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Bhasin-Chhabra B, Koratala A. Point of care ultrasonography in onco-nephrology: A stride toward better physical examination. World J Nephrol 2023; 12:29-39. [PMID: 37035508 PMCID: PMC10075017 DOI: 10.5527/wjn.v12.i2.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/27/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023] Open
Abstract
Onco-Nephrology is an emerging subspecialty of Nephrology that focuses on a broad spectrum of renal disorders that can arise in patients with cancer. It encompasses acute kidney injury (AKI), complex fluid, electrolyte, and acid-base disorders, as well as chronic kidney disease caused or exacerbated by cancer and/or its treatment. In many such scenarios including AKI and hyponatremia, objective evaluation of hemodynamics is vital for appropriate management. Point of care ultrasonography (POCUS) is a limited ultrasound exam performed at the bedside and interpreted by the treating physician intended to answer focused clinical questions and guide therapy. Compared to conventional physical examination, POCUS offers substantially higher diagnostic accuracy for various structural and hemodynamic derangements. In this narrative review, we provide an overview of the utility of POCUS enhanced physical examination for the Onconephrologist supported by the current evidence and our experience-based opinion.
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Affiliation(s)
- Bhavna Bhasin-Chhabra
- Division of Nephrology and Hypertension, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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21
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Turk M, Robertson T, Koratala A. Point-of-care ultrasound in diagnosis and management of congestive nephropathy. World J Crit Care Med 2023; 12:53-62. [PMID: 37034023 PMCID: PMC10075049 DOI: 10.5492/wjccm.v12.i2.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/08/2023] [Accepted: 02/17/2023] [Indexed: 03/07/2023] Open
Abstract
Congestive nephropathy is kidney dysfunction caused by the impact of elevated venous pressures on renal hemodynamics. As a part of cardiorenal syndrome, the diagnosis is usually made based on history and physical examination, with findings such as jugular venous distension, a third heart sound, and vital signs as supporting findings. More recently, however, these once though objective measures have come under scrutiny for their accuracy. At the same time, bedside ultrasound has increased in popularity and is routinely being used by clinicians to take some of the guess work out of making the diagnosis of volume overload and venous congestion. In this mini-review, we will discuss some of the traditional methods used to measure venous congestion, describe the role of point-of-care ultrasound and how it can ameliorate a clinician’s evaluation, and offer a description of venous excess ultrasound score, a relatively novel scoring technique used to objectively quantify congestion. While there is a paucity of published large scale clinical trials evaluating the potential benefit of ultrasonography in venous congestion compared to gold standard invasive measurements, more study is underway to solidify the role of this objective measure in daily clinical practice.
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Affiliation(s)
- Michael Turk
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA 15222, United States
| | - Thomas Robertson
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA 15222, United States
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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22
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Johri AM, Glass C, Hill B, Jensen T, Puentes W, Olusanya O, Capizzano JN, Dancel R, Reierson K, Reisinger N, Liblik K, Galen BT. The Evolution of Cardiovascular Ultrasound: A Review of Cardiac Point-of-Care Ultrasound (POCUS) Across Specialties. Am J Med 2023:S0002-9343(23)00158-4. [PMID: 36889497 DOI: 10.1016/j.amjmed.2023.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023]
Abstract
The use of cardiac point-of-care ultrasound (POCUS) is now widespread in clinics, emergency departments, and all areas of the hospital. Users include medical trainees, advanced practice practitioners, and attending physicians in many specialties and sub-specialties. Opportunities to learn cardiac POCUS and requirements for training vary across specialties as does the scope of the cardiac POCUS examination. In this review, we describe both a brief history of how cardiac POCUS emerged from echocardiography and the state of the art across a variety of medical fields.
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Affiliation(s)
- Amer M Johri
- Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - Casey Glass
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Braeden Hill
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Trevor Jensen
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Wilfredo Puentes
- Department of Anesthesia, Western University, London, ON, Canada
| | - Olusegun Olusanya
- Department of Critical Care, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | | | - Ria Dancel
- Departments of Internal Medicine and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kreegan Reierson
- Department of Hospital Medicine, HealthPartners Medical Group, Minnesota and Wisconsin, USA
| | - Nathaniel Reisinger
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA, USA
| | - Kiera Liblik
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Benjamin T Galen
- Department of Internal Medicine, Division of Hospital Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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23
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Koratala A. Point-of-Care Ultrasound in Peritoneal Dialysis Patients: Look Beyond the Catheter. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3163-3164. [PMID: 35603640 DOI: 10.1002/jum.16009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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24
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Greenberg KI, Pourafshar N, Choi MJ. Current Trends and Challenges in Nephrology Fellowship Training: Expansion of Education in Home Dialysis, Palliative Care, and Point-of-Care Ultrasound. Adv Chronic Kidney Dis 2022; 29:510-515. [PMID: 36371114 DOI: 10.1053/j.ackd.2022.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/15/2022] [Accepted: 07/13/2022] [Indexed: 11/11/2022]
Abstract
Nephrology education has changed significantly since the first nephrology fellowship programs were established in the United States in the 1950s and 1960s. The past several years have seen increased opportunities for subspecialization in areas such as interventional nephrology, onconephrology, and glomerular disease. Notable trends in fellowship curricula include the expansion of education in home dialysis and palliative care, driven by policy changes and focus on patient-centered care. In addition, point-of-care ultrasound has garnered significant interest due to its potential to provide diagnostic information that improves patient care. An important area that remains largely unaddressed appears to be education about the business and administrative aspects of nephrology. Meanwhile, the importance of training in hemodialysis catheter placement and kidney biopsy has come into question due to the small proportion of nephrologists performing these procedures today. Nephrology fellowship programs should strive to tailor their curriculum to meet the interests and needs of individual fellows.
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25
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Koratala A, Reisinger N. Point of Care Ultrasound in Cirrhosis-Associated Acute Kidney Injury: Beyond Inferior Vena Cava. KIDNEY360 2022; 3:1965-1968. [PMID: 36514396 PMCID: PMC9717633 DOI: 10.34067/kid.0005522022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/20/2022] [Indexed: 12/05/2022]
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26
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Reisinger NC, Koratala A. Incorporating Training in POCUS in Nephrology Fellowship Curriculum. Clin J Am Soc Nephrol 2022; 17:1442-1445. [PMID: 36130825 PMCID: PMC9528260 DOI: 10.2215/cjn.09580822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
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27
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Abstract
Point-of-care ultrasound (POCUS) has evolved in recent years in clinical practice, helping in early bedside diagnosis of important etiologies. Many medical schools and training programs are integrating POCUS into their curriculum. Especially with the technological advances of newer handheld ultrasound devices, POCUS has now become a component adjunct to clinical examination, in the clinic and bedside in critical care units. The diagnostic utility of POCUS lies both in early identification of critical kidney disease, and also extra-renal pathologies from a focused cardiac ultrasound, lung ultrasound, and integrated fluid assessment. There is a need to incorporate POCUS in training in pediatric nephrology and establish competency standard criteria. This review shall cover how POCUS helps in enhancing patient care in pediatric kidney disorders and critical children, and the recent advances.
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28
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Bhasin-Chhabra B, Veitla V, Weinberg S, Koratala A. Demystifying hyponatremia: A clinical guide to evaluation and management. Nutr Clin Pract 2022; 37:1023-1032. [PMID: 36036229 DOI: 10.1002/ncp.10907] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/18/2022] [Accepted: 08/05/2022] [Indexed: 12/20/2022] Open
Abstract
Hyponatremia (serum sodium <135 mEq/L) is a frequent electrolyte abnormality complicating the clinical care of hospitalized patients. Hyponatremia has been associated with an increased risk of mortality. Hyponatremia can be seen in patients with euvolemia, hypovolemia, or hypervolemia. Evaluation of hyponatremia relies on clinical assessment and estimation of serum sodium, urine electrolytes, and serum and urine osmolality in addition to other case-specific laboratory parameters. In addition, point-of-care ultrasonography is an important adjunct to physical assessment in estimation of volume status. Understanding the pathophysiology of the underlying process can lead to a timely diagnosis and appropriate management of hyponatremia.
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Affiliation(s)
- Bhavna Bhasin-Chhabra
- Division of Nephrology, Department of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Vineet Veitla
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Samuel Weinberg
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Abhilash Koratala
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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29
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Bajaj D, Koratala A. Utility of portal venous Doppler in the assessment of fluid status in end-stage kidney disease: think beyond IVC ultrasound. CEN Case Rep 2022; 11:285-287. [PMID: 34750766 PMCID: PMC9061910 DOI: 10.1007/s13730-021-00661-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/04/2021] [Indexed: 12/31/2022] Open
Affiliation(s)
- Divyansh Bajaj
- Division of Pulmonary, Critical Care and Sleep Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Room A 7666, 8701 W Watertown Plank Rd, Wauwatosa, Milwaukee, WI, 53226, USA.
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30
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Abstract
Ultrasound imaging is a key investigatory step in the evaluation of chronic kidney disease and kidney transplantation. It uses nonionizing radiation, is noninvasive, and generates real-time images, making it the ideal initial radiographic test for patients with abnormal kidney function. Ultrasound enables the assessment of both structural (form and size) and functional (perfusion and patency) aspects of kidneys, both of which are especially important as the disease progresses. Ultrasound and its derivatives have been studied for their diagnostic and prognostic significance in chronic kidney disease and kidney transplantation. Ultrasound is rapidly growing more widely accessible and is now available even in handheld formats that allow for bedside ultrasound examinations. Given the trend toward ubiquity, the current use of kidney ultrasound demands a full understanding of its breadth as it and its variants become available. We described the current applications and future directions of ultrasound imaging and its variants in the context of chronic kidney disease and transplantation in this review.
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Affiliation(s)
- Rohit K. Singla
- MD and PhD Program, University of British Columbia, Vancouver, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
- Address for Correspondence: Rohit Singla, MASc, The University of British Columbia, 2332 Main Mall, Vancouver, BC, Canada, V6T 1Z4.
| | - Matthew Kadatz
- Department of Nephrology, University of British Columbia, Vancouver, Canada
| | - Robert Rohling
- School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada
| | - Christopher Nguan
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
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Koratala A, Ronco C, Kazory A. Multi-Organ Point-Of-Care Ultrasound in Acute Kidney Injury. Blood Purif 2022; 51:967-971. [DOI: 10.1159/000522652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/14/2022] [Indexed: 12/28/2022]
Abstract
Acute kidney injury (AKI) is a clinical syndrome caused by a multitude of hemodynamic, toxic, and structural insults to the kidney, and portends worse patient outcomes. Despite careful history taking, physical examination, and analysis of laboratory data, a void is evident in the diagnostic process and clinical monitoring of AKI. Point-of-care ultrasonography (POCUS) is a limited ultrasound study performed by the clinician at bedside as an adjunct to physical examination. Growing body of evidence points to POCUS as a powerful tool in a variety of clinical settings. Herein, we discuss how nephrologist-performed POCUS has the potential to provide answers to focused questions that we encounter in diagnosis and management of patients with AKI. From excluding hydronephrosis to providing real-time insights into hemodynamics, incorporation of POCUS helps integrate all the pieces of patient data and formulate individualized treatment plans. Future studies are needed to evaluate the impact of multi-organ POCUS on AKI-related pragmatic patient outcomes, the potential of this technique to stratify the risk and to identify patients with different levels of severity of AKI and different pathophysiological signatures.
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Taleb Abdellah A, Koratala A. Nephrologist-performed Point-of-Care Ultrasound in Acute Kidney Injury: beyond Hydronephrosis. Kidney Int Rep 2022; 7:1428-1432. [PMID: 35685325 PMCID: PMC9171614 DOI: 10.1016/j.ekir.2022.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Correspondence: Abhilash Koratala, Division of Nephrology, Medical College of Wisconsin, 8701 West Watertown Plank Road, Room A 7633, Wauwatosa, Wisconsin 53226, USA.
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Point-of-care renal ultrasound: the SECONDS checklist. Clin Exp Nephrol 2022; 26:486-487. [PMID: 35013843 DOI: 10.1007/s10157-021-02171-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/07/2021] [Indexed: 12/28/2022]
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