Inferior vena cava diameter and left atrial diameter measure volume but not dry weight

Clin J Am Soc Nephrol. 2011 May;6(5):1066-72. doi: 10.2215/CJN.09321010. Epub 2011 Feb 17.


Background and objectives: Hypervolemia is an important and modifiable cause of hypertension. Hypertension improves with probing dry weight, but its effect on echocardiographic measures of volume is unknown.

Design, setting, participants, & measurements: Shortly after dialysis, echocardiograms were obtained at baseline and longitudinally every 4 weeks on two occasions. Among 100 patients in the additional ultrafiltration group, 198 echocardiograms were performed; among 50 patients in the control group, 104 echocardiograms were performed.

Results: Baseline inferior vena cava (IVC)(insp) diameter was approximately 5.1 mm/m(2); with ultrafiltration, change in IVC(insp) diameter was -0.95 mm/m(2) more compared with the control group at 4 weeks and -1.18 mm/m(2) more compared with the control group at 8 weeks. From baseline IVC(exp) diameter of approximately 8.2 mm/m(2), ultrafiltration-induced change at 4 weeks was -1.06 mm/m(2) more and at 8 weeks was -1.07 mm/m(2) more (P=0.044). From a baseline left atrial diameter of 2.1 cm/m(2), ultrafiltration-induced change at 4 weeks was -0.14 cm/m(2) more and at 8 weeks was -0.15 cm/m(2) more. At baseline, there was no relationship between interdialytic ambulatory BP and echocardiographic parameters of volume. The reduction in interdialytic ambulatory BP was also independent of change in the echocardiographic volume parameters.

Conclusions: The inferior vena cava and left atrial diameters are echocardiographic parameters that are responsive to probing dry weight; thus, they reflect excess volume. However, echocardiographic volume parameters are poor determinants of interdialytic BP, and their change does not predict the BP response to probing dry weight.

Trial registration: NCT00067665.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Antihypertensive Agents / therapeutic use
  • Atrial Function / physiology
  • Blood Pressure / physiology
  • Blood Pressure Monitoring, Ambulatory
  • Blood Volume / physiology*
  • Echocardiography / methods*
  • Female
  • Heart Atria / diagnostic imaging
  • Humans
  • Hypertension, Renal / diagnostic imaging*
  • Hypertension, Renal / drug therapy
  • Hypertension, Renal / physiopathology
  • Kidney Failure, Chronic / physiopathology
  • Kidney Failure, Chronic / therapy*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Organ Size
  • Predictive Value of Tests
  • Renal Dialysis / methods*
  • Vena Cava, Inferior / diagnostic imaging*


  • Antihypertensive Agents

Associated data