Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 12 3 2026 02 02 281 287 EN Mohamed Abdalla Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Helen Rizk Critical Care and Intensive Care Medicine Department, Faculty of Medicine, Misr University for Science and Technology (MUST), 6th of October City, Egypt. Hossam Mowafi Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Kamel Mohammed Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Mohamed Elansary Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt. 2025 08 02 2025 08 11 Background: Intradialytic hypotension (IDH) is a common and serious complication of intermittent hemodialysis (IHD) in critically ill patients with acute kidney injury (AKI). Accurate pre-dialysis risk stratification remains a challenge, particularly in the ICU. This study aims to determine whether ultrasound-based cardiopulmonary profiles could predict IDH in this high-risk population. Methods: This prospective cohort study included 100 critically ill adults undergoing IHD for AKI. All patients underwent pre-dialysis echocardiography and lung/inferior vena cava (IVC) ultrasound to assess stroke volume, cardiac output, B-lines, and IVC collapsibility index (IVC-CI). Patients were divided into two groups based on the presence or absence of IDH. Results: IDH occurred in 35% of patients. Significant predictors of IDH included lower systolic blood pressure (124.86 ±16.02 vs. 139.92 ±22.8 mmHg, P < 0.001), higher IVC-CI [51% (13–58) vs. 27.38% (13–60), P < 0.001], sepsis (88.6% vs. 70.8%, P = 0.044), and elevated potassium (5.17 ±1.34 vs. 4.62 ±0.87 mmol/L, P = 0.015). Multivariate analysis identified IVC-CI (OR = 1.097, P < 0.001) and SBP (OR = 0.942, P = 0.001) as independent predictors. IVC-CI >49.5% predicted IDH with 68.6% sensitivity and 87.7% specificity (AUC = 0.757, 95% CI: 0.652–0.862). Conclusion: Ultrasound-derived IVC-CI is a valuable, noninvasive tool for predicting IDH in critically ill patients receiving IHD. Incorporating sonographic profiles into routine pre-dialysis evaluation may enhance risk stratification and improve dialysis safety. https://aacc.tums.ac.ir/index.php/aacc/article/view/1362