Target Weight Optimization based on a Modified VExUS Protocol in Hemodialysis: The VexHD Prospective Multi-Center Study

@article{ramos2026target,
  title = {{Target Weight Optimization based on a Modified VExUS Protocol in Hemodialysis: The VexHD Prospective Multi-Center Study}},
  author = {Patricia Muñoz Ramos and Alberto Ortiz and Ana B. Sanz and Martín Giorgi and Paloma Ruiz López-Alvarado and Irene Oñate and Verónica Ruth Mercado and José Carlos de La Flor Merino and Marco Vaca Gallardo and María Lina León-Machado and Virginia López de la Manzanara and Mohammad Manouchehri and Carlos Santos Alonso and Susana Carrasco and Miguel Ángel Navas Jiménez and Patricia de Sequera and Borja Quiroga and on behalf of the VExHD study collaborators group},
  journal = {Cardiorenal Medicine},
  year = {2026},
  month = oct,
  doi = {10.1159/crm/abtag011},
  url = {https://doi.org/10.1159/crm/abtag011},
  note = {CC BY-NC 4.0},
}

TY  - JOUR
TI  - Target Weight Optimization based on a Modified VExUS Protocol in Hemodialysis: The VexHD Prospective Multi-Center Study
AU  - Patricia Muñoz Ramos
AU  - Alberto Ortiz
AU  - Ana B. Sanz
AU  - Martín Giorgi
AU  - Paloma Ruiz López-Alvarado
AU  - Irene Oñate
AU  - Verónica Ruth Mercado
AU  - José Carlos de La Flor Merino
AU  - Marco Vaca Gallardo
AU  - María Lina León-Machado
AU  - Virginia López de la Manzanara
AU  - Mohammad Manouchehri
AU  - Carlos Santos Alonso
AU  - Susana Carrasco
AU  - Miguel Ángel Navas Jiménez
AU  - Patricia de Sequera
AU  - Borja Quiroga
AU  - on behalf of the VExHD study collaborators group
PY  - 2026
DA  - 2026/10/15
JO  - Cardiorenal Medicine
DO  - 10.1159/crm/abtag011
UR  - https://doi.org/10.1159/crm/abtag011
AB  - 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.
SN  - 1664-3828
SN  - 1664-5502
ER  -