Accurate assessment of volume status (VS) in hemodialysis (HD) patients is challenging. The use of chest ultrasound (CUS) for detection of extravascular lung water has recently gained wide acceptance. The aim of this study was to evaluate the use of CUS in VS assessment in HD patients in comparison to clinical and inferior vena cava (IVC) indices and to assess their relationship with volume displacement after ultrafiltration. This prospective cohort study was carried out on 38 patients on regular HD. VS was assessed using a 13-point clinical score, and IVC indices and CUS score were measured pre- and post-ultrafiltration. Correlation between these
parameters and with ultrafiltration volume was tested. There was a statistically significant reduction in post-ultrafiltration CUS score and the 13-point clinical score (P <0.01). Moreover, reduction in all the IVC indices (inspiratory and expiratory diameters and collapsing index) was detected but did not reach statistical significance (P = 0.185, P = 0.296, and P = 0.194, respectively). CUS score had statistically significant correlations with ultrafiltration volume and New York Heart Association classes (P <0.001 and <0.001, respectively). Neither clinical signs nor IVC indices can be used independently for the assessment of VS in HD patients. CUS is a useful guide in VS assessment, and we recommend its routine use in the management of HD patients. Concomitant use of bioimpedance analysis (BIA) may be needed in addition to CUS for more accurate assessment of VS in HD patients.