Hemodynamic phenotypes in Nephrology
This table (from our KI reports article) summarizes common POCUS findings in various hemodynamic phenotypes that we encounter in day-to-day nephrology practice. Basic POCUS (without cardiac Doppler) cannot differentiate between hypovolemia and high output states, which is why I stress on learning at least a few important Doppler applications.
Vasodilatory/high output state is commonly seen in patients with cirrhosis. There is really no need to fill the circulation with albumin if the cardiac output is already high (remember, the role of colloid or crystalloid in hypovolemic states is to increase the cardiac output). Such patients may benefit from early initiation of vasopressor therapy. Needless to say, vasopressors alone might not improve the outcome as these patients often have co-existing renal insults such as cholemic nephropathy, intra-abdominal hypertension, ischemic acute tubular injury etc. At least, POCUS increases the diagnostic confidence and avoids iatrogenic fluid overload. There is mounting evidence that positive fluid balance during hospitalization is associated with worse outcome.