Journal Article

Renal Doppler ultrasound on admission to predict acute kidney injury in patients with acute circulatory failure

Aggarwal, Richa, Darlong, Vanalal, Baidya, Dalim Kumar, Devasenathipathy, K., Soni, Kapil Dev, Rajaraman, Balaji

2024

Overview

Acute kidney Injury (AKI) is common and is associated with poor outcomes in critically ill patients. Current diagnosis and staging of AKI depends on measurement of urine output and serum creatinine. Both of them have their own fallacies and therefore diagnosis of AKI is often delayed. Use of novel biomarkers for diagnosis of AKI have been complicated by their costs, lack of availability and validation in critically ill patients. Of late, renal ultrasonography and Doppler have gained importance in the detection of AKI in early stages. The aim of this study was to determine whether renal Doppler parameters at admission can predict the development of AKI at day 5 in patients with acute circulatory failure. After ethics committee approval and informed written consent, we recruited 80 adult patients with acute circulatory failure in this single center, prospective observational study. We measured renal resistive index (RRI), power Doppler ultrasound (PDU) score and their ratio (RRI/PDU) at admission to ICU. Other baseline characteristics, resuscitation parameters and level of organ support were noted. Outcome was AKI at day 5. Statistical analysis was performed using SPSS 21.0 software (IBM, Chicago, USA). Univariate logistic regression was used to assess predictive ability and receiver operating characteristic (ROC) curve was used to predict sensitivity and specificity of renal Doppler ultrasound parameters for prediction of AKI. N = 32 patients developed AKI. Baseline and demographic data were comparable between AKI and non-AKI groups. At day 1, RRI (AKI vs non-AKI: 0.62 ± 0.08 vs 0.51 ± 0.03; p < 0.0001) and RRI/PDU (AKI vs non-AKI: 0.4 ± 0.2 vs 0.2 ± 0.06; p < 0.0001) were significantly higher and PDU (AKI vs non-AKI: 1.88 ± 0.66 vs 2.71 ± 0.5; p < 0.0001) was significantly lower in patients with AKI as compared to non-AKI group. Based on ROC curve, RRI/PDU was the best predictor of AKI (AUROC 0.88, cut off >0.24, sensitivity 84%, specificity 83%; Fig. 1) compared to other parameters (RRI AUROC 0.87, cut off >0.56, sensitivity 68%, specificity 97%; PDU AUROC 0.81, cut off ≤2, sensitivity 84%, specificity 72%). Renal Doppler parameters (RRI, PDU and RRI/PDU) at admission can predict AKI in critically ill patients with acute circulatory failure. The RRI/PDU at day 1 has highest predictive ability compared to other parameters.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Acute kidney injury / Color Doppler ultrasonography / Critical care / Hemodynamics / Kidneys / Medical prognosis / Shock / Ultrasonic imaging