Renal Resistive Index and Acute Kidney Injury in Aortic Surgery: An Observational Pilot Study

Acute kidney injury (AKI) following transcatheter aortic valve replacement (TAVR) is associated with a dismal prognosis. Elevated renal resistive index (RRI), through renal Doppler ultrasound (RDU) evaluation, has been associated with AKI development and increased systemic arterial stiffness. Our pilot study aimed to investigate the performance of Doppler based RRI to predict AKI and outcomes in TAVR patients. From May 2018 to May 2019, 100 patients with severe aortic stenosis were prospectively enrolled for TAVR and concomitant RDU evaluation at our institution (Nouvel Hôpital Civil, Strasbourg University, France). AKI by serum Creatinine (sCr-AKI) was defined according to the VARC-2 definition and AKI by serum Cystatin C (sCyC-AKI) was defined as an sCyC increase of greater than 15% with baseline value. Concomitant RRI measurements as well as renal and systemic hemodynamic parameters were recorded before, one day, and three days after TAVR. It was found that 10% of patients presented with AKIsCr and AKIsCyC. The whole cohort showed higher baseline RRI values (0.76 ± 0.7) compared to normal known and accepted values. AKIsCyC had significant higher post-procedural RRI one day (Day 1) after TAVR (0.83 ± 0.1 vs. 0.77 ± 0.6, CI 95%, p = 0.005). AUC for AKIsCyC was 0.766 and a RRI cut-off value of ≥ 0.795 had the most optimal sensitivity/specificity (80/62%) combination. By univariate Cox analysis, Mehran Risk Score, higher baseline right atrial pressure at baseline >0.8 RRI values one day after TAVR (HR 6.5 (95% CI 1.3–32.9; p = 0.021) but not RRI at baseline were significant predictors of AKIsCyC. Importantly, no significant impact of baseline biological parameters, renal or systemic parameters could be demonstrated. Doppler-based RRI can be helpful for the non-invasive assessment of AKI development after TAVR.

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Renal resistive index as a biomarker for acute kidney injury in aortic valve surgery

Journal of Thoracic Disease ◽

10.21037/jtd.2018.09.45 ◽

2018 ◽

Vol 10 (S33) ◽

pp. S4010-S4012

Author(s):

Thin Xuan Vo ◽

Munir Boodhwani

Keyword(s):

Acute Kidney Injury ◽

Aortic Valve ◽

Resistive Index ◽

Kidney Injury ◽

Valve Surgery ◽

Renal Resistive Index ◽

Aortic Valve Surgery

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Semiquantitative Power Doppler Ultrasound Score to Predict Acute Kidney Injury in Patients With Sepsis or Cardiac Failure: A Prospective Observational Study

Journal of Intensive Care Medicine ◽

10.1177/0885066619887333 ◽

2019 ◽

Vol 36 (1) ◽

pp. 115-122 ◽

Cited By ~ 1

Author(s):

Hai Jun Zhi ◽

Jing Zhao ◽

Shen Nie ◽

Yun Jie Ma ◽

Xiao Ya Cui ◽

...

Keyword(s):

Acute Kidney Injury ◽

Doppler Ultrasound ◽

Cardiac Failure ◽

Power Doppler ◽

Resistive Index ◽

Kidney Injury ◽

Renal Resistive Index ◽

Power Doppler Ultrasound ◽

Predictive Values ◽

Ultrasound Score

Background: Diagnosing acute kidney injury (AKI) stage 3 in critically ill patients may help physicians in making treatment decisions. This diagnosis relies chiefly on urinary output and serum creatinine, which may be of limited value. This study aimed to explore the diagnostic performance of renal resistive index (RRI) and semiquantitative power Doppler ultrasound (PDU) scores in predicting AKI stage 3 in patients with sepsis or cardiac failure. Methods: This study is a prospective observational study that included 83 patients (40 with sepsis and 43 with cardiac failure). Renal resistive index and semiquantitative PDU scores were measured within 6 hours following admission to the intensive care unit. Acute kidney injury was defined according to the criteria set by Kidney Disease Improving Global Outcomes. Results: The predictive values of RRI (area under the curve [AUC] = 0.772, 95% confidence interval [CI] = 0.658-0.886) and PDU score (AUC = 0.780, 95% CI = 0.667-0.892) were similar in all patients. Power Doppler ultrasound score (AUC = 0.910, 95% CI = 0.815-1.000) could effectively predict AKI stage 3 in the cardiac failure subgroup, and the optimal cutoff for this parameter was ≤ 1 (sensitivity = 87.5%, specificity = 92.6%, Youden index = 0.801, accuracy in our population = 90.7%). However, PDU scores (AUC = 0.620, 95% CI = 0.425-0.814) could not predict AKI stage 3 in the sepsis subgroup. The predictive values of RRI for AKI stage 3 in the cardiac failure (AUC = 0.820, 95% CI = 0.666-0.974) and sepsis (AUC = 0.724, 95% CI = 0.538-0.910) subgroups were similar. Conclusions: Power Doppler ultrasound scores could effectively predict AKI stage 3 in patients with cardiac failure but not in patients with sepsis. Renal resistive index is a poor predictor of AKI stage 3 in patients with sepsis or cardiac failure.

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Intraoperative renal resistive index threshold as an acute kidney injury biomarker

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2019.109626 ◽

2020 ◽

Vol 61 ◽

pp. 109626 ◽

Cited By ~ 3

Author(s):

Anne D. Cherry ◽

Jennifer N. Hauck ◽

Benjamin Y. Andrew ◽

Yi-Ju Li ◽

Jamie R. Privratsky ◽

...

Keyword(s):

Acute Kidney Injury ◽

Resistive Index ◽

Kidney Injury ◽

Renal Resistive Index

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Early detection of postoperative acute kidney injury by Doppler renal resistive index in major lung and cardiac operations

Critical Care ◽

10.1186/cc13555 ◽

2014 ◽

Vol 18 (Suppl 1) ◽

pp. P365

Author(s):

M Arslantas ◽

I Cinel ◽

A Kararmaz

Keyword(s):

Acute Kidney Injury ◽

Early Detection ◽

Resistive Index ◽

Kidney Injury ◽

Renal Resistive Index ◽

Cardiac Operations

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Comparison of Neutrophil Gelatinase-associated Lipocalin and Renal Resistive Index as Acute Kidney Injury Predictor in Critically Ill Patients at ICU H. Adam Malik Hospital Medan

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.7014 ◽

2021 ◽

Vol 9 (B) ◽

pp. 1637-1639

Author(s):

Muhammad Aldi Rivai Ginting ◽

Achsanuddin Hanafie ◽

Bastian Lubis

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Critically Ill ◽

Critically Ill Patients ◽

Resistive Index ◽

Kidney Injury ◽

Renal Resistive Index ◽

Ngal Level ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase

BACKGROUND: Acute kidney injury (AKI) is a complication found in critically ill patients. Current consensus explains that diagnosis of AKI based on increased serum creatinine and decreased urine output. Neutrophil gelatinase-associated lipocalin (NGAL) level is increased a few hours after tubular damage occurred and can predict AKI more significantly than serum creatinine. Renal resistive index (RRI) is also a good marker in predicting the early stage of AKI. AIM: This study aimed to compare RRI and NGAL level as marker to predict incidence of AKI in critically ill patients treated in the Intensive Care Unit (ICU) at H. Adam Malik Hospital Medan. METHODS: This was an observational prospective cohort study and conducted in ICU at H. Adam Malik Hospital Medan in April-May 2021. This study had been approved by the Ethics Committee of Faculty of Medicine, Sumatera Utara University and H. Adam Malik Hospital Medan. Inclusion criteria are critical patients aged 18–65 years with 1st and 2nd priority level. Consecutive sampling was used. Resistive Index (RI) measured using USG Doppler by researcher and the results confirmed by ICU supervisors, while urine NGAL level measured within 3 h after ICU admission. Plasma urea and creatinine level measured after 24h after ICU admission. RESULTS: A total of 40 samples were collected; percentage of men and women are 66–35%, respectively (p = 0.001). There was a significant difference RI between AKI-group and non-AKI group (0.719 ± 0.060 and 0.060 ± 0.077, respectively) (p = 0.001). RI has a sensitivity of 71%, specificity of 84%, and accuracy of 87% in predicting occurrence of AKI with AUROC = 0.873. Meanwhile, NGAL has a sensitivity, specificity, and accuracy (66%, 89%, 78%, respectively) in early prediction of AKI incidence in critically ill patients. CONCLUSION: RI value was higher in AKI group than non-AKI group. RRI has better sensitivity than NGAL in predicting incidence of AKI.

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