Ultrasound in Hemodialysis: Current Application Status and Future Perspectives

Abstract Maintenance hemodialysis (MHD) patients face significant challenges, including high cardiovascular risk and vascular access complications. Ultrasound has emerged as a vital, noninvasive tool for managing these aspects of care. Despite its utility, limitations such as operator dependency and a lack of standardized protocols persist, hindering optimal clinical integration. This narrative review aims to summarize the current applications of ultrasound in hemodialysis management and explore future technological and therapeutic innovations. The review outlines ultrasound’s roles in evaluating cardiovascular function, establishing and monitoring vascular access, guiding dialysis procedures, and assessing dynamic volume status. It also highlights emerging perspectives, including artificial intelligence (AI)-assisted analytics, portable devices, super-resolution imaging, and multimodal fusion that promise to enhance diagnostic precision and accessibility. Furthermore, emerging therapeutic roles of ultrasound in alleviating MHD-related symptoms such as sarcopenia and neurological dysfunction are discussed. In conclusion, ultrasound is essential for personalized hemodialysis care. Future efforts should focus on validating AI tools, refining real-time monitoring, and streamlining clinical integration to improve patient outcomes.