Nephrology-Oriented Point of Care Ultrasound Education and Subsequence: Clinical Usefulness for Nephrology Fellows From a Japanese Teaching Hospital.

Abstract

Aim: Point-of-care ultrasound (POCUS) is an essential bedside tool in nephrology for evaluation of fluid volume, acute kidney injury (AKI), and vascular access. In Japan, nephrology-oriented POCUS education remains underdeveloped, despite its clinical significance. This study aimed to evaluate the effects of a POCUS educational programme on POCUS implementation in clinical nephrology.

Methods: This single-centre observational study was conducted between 2022 and 2024 and comprised 162 patients with AKI. We compared POCUS use, including the checking of the inferior vena cava diameter, urinary obstruction, and venous excess ultrasound (VExUS) grading system, before and after lectures and hands-on training in 2023.

Results: There was a significant increase in POCUS implementation for AKI evaluation, including VExUS for assessing congestion. Post-training, the procedure implementation of VExUS for patients with congestion (N = 29) increased from 0% in 2022 to 66.7% in 2023 and 56.3% in 2024. Severe congestion by VExUS might be related to poor outcomes, including higher rates of haemodialysis and mortality. Despite technical difficulties in visualising renal interlobular veins using pulse-wave Doppler in VExUS, the visualisation rate improved over time, increasing from 50% in 2023 to 66.7% in 2024.

Conclusions: These results underscore the importance of developing comprehensive nephrology-oriented POCUS training programmes, even at the facility level, coupled with on-the-job training to improve clinical use. However, the procedure implementation of VExUS plateaued in years when the lectures were not conducted. Thus, regularly conducted lectures, the development of supervising physicians' teaching skills, and the implementation of a robust training system would be necessary.