Abstract Body (Do not enter title and authors here): Introduction:
Venous Excess Ultrasound (VExUS), a novel Doppler-based scoring system to evaluate venous congestion, may provide insight into how and when to diurese patients with acute decompensated heart failure (ADHF). The current study evaluates the potential utility of VExUS as a bedside tool to diagnose, monitor, and guide diuresis among patients with ADHF and cardiorenal acute kidney injury (AKI).

Hypothesis:
VExUS can be used to predict presence or absence of AKI, in addition to guiding diuretic therapy.

Methods:
In this observational study we prospectively enrolled patients in the emergency department (ED) of a tertiary medical center with a presumptive diagnosis of ADHF. Patients underwent standardized VExUS scanning prior to administration of initial dose of loop diuretic, on hospital days 1-3, and on discharge. VExUS scans were graded on a scale of 0 (no congestion) to 3 (severe congestion) by providers experienced in VExUS scoring.

Results:
VExUS Grade demonstrated a statistically significant linear decrease over time as patients underwent diuresis (p = <0.001). This change was significantly associated with change in fluid balance (p = 0.005). After adjusting for age, sex, and Charlson Comorbidity Index (CCI), admission VExUS grade was associated with the presence of acute kidney injury on admission, per KDIGO criteria(p = 0.01).⁴¹ Among patients presenting with volume overload and elevated creatinine that underwent diuresis, there was a significant indirect association between elevated VExUS grade and subsequent change in serum creatinine (p <0.001).

Conclusion:
These results suggest that VExUS may be an accurate and dynamic indicator of venous congestion. Furthermore, it may be able to guide diuresis in patients with AKI of uncertain etiology. The fact that a low VExUS grade predicted an increase in creatinine following diuresis is a promising sign that Doppler assessment of hemodynamics can provide bedside providers with valuable insight to help them decide when to diurese patients with AKI of uncertain etiology, thereby limiting iatrogenic AKI when trying to decongest patients.