scholarly journals Renal resistive index is associated with acute kidney injury in COVID-19 patients treated in the intensive care unit

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Mårten Renberg ◽  
Olof Jonmarker ◽  
Naima Kilhamn ◽  
Claire Rimes-Stigare ◽  
Max Bell ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Resistive Index ◽  
Kidney Injury ◽  
University Hospital ◽  
Renal Resistive Index ◽  
Promising Tool ◽  
Stage 1

Abstract Background Renal resistive index (RRI) is a promising tool for the assessment of acute kidney injury (AKI) in critically ill patients in general, but its role and association to AKI among patients with Coronavirus disease 2019 (COVID-19) is not known. Objective The aim of this study was to describe the pattern of RRI in relation to AKI in patients with COVID-19 treated in the intensive care unit. Methods In this observational cohort study, RRI was measured in COVID-19 patients in six intensive care units at two sites of a Swedish University Hospital. AKI was defined by the creatinine criteria in the Kidney Disease Improving Global Outcomes classification. We investigated the association between RRI and AKI diagnosis, different AKI stages and urine output. Results RRI was measured in 51 patients, of which 23 patients (45%) had AKI at the time of measurement. Median RRI in patients with AKI was 0.80 (IQR 0.71–0.85) compared to 0.72 (IQR 0.67–0.78) in patients without AKI (p = 0.004). Compared to patients without AKI, RRI was higher in patients with AKI stage 3 (median 0.83, IQR 0.71–0.85, p = 0.006) but not in patients with AKI stage 1 (median 0.76, IQR 0.71–0.83, p = 0.347) or AKI stage 2 (median 0.79, min/max 0.79/0.80, n = 2, p = 0.134). RRI was higher in patients with an ongoing AKI episode compared to patients who never developed AKI (median 0.72, IQR 0.69–0.78, p = 0.015) or patients who developed AKI but had recovered at the time of measurement (median 0.68, IQR 0.67–0.81, p = 0.021). Oliguric patients had higher RRI (median 0.84, IQR 0.83–0.85) compared to non-oliguric patients (median 0.74, IQR 0.69–0.81) (p = 0.009). After multivariable adjustment, RRI was independently associated with AKI (OR for 0.01 increments of RRI 1.22, 95% CI 1.07–1.41). Conclusions Critically ill COVID-19 patients with AKI have higher RRI compared to those without AKI, and elevated RRI may have a role in identifying severe and oliguric AKI at the bedside in these patients.

scholarly journals Renal Resistive Index is Associated With Acute Kidney Injury in COVID-19 Patients Treated in the ICU

2020 ◽  
Author(s):  
Mårten Renberg ◽  
Olof Jonmarker ◽  
Naima Kilhamn ◽  
Claire Rimes-Stigare ◽  
Max Bell ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Resistive Index ◽  
Kidney Injury ◽  
Observational Cohort Study ◽  
University Hospital ◽  
Renal Resistive Index ◽  
Promising Tool ◽  
Observational Cohort ◽  
Stage 1

Abstract Background: Renal resistive index (RRI) is a promising tool for prediction of acute kidney injury (AKI) in critically ill patients but is not described among patients with Coronavirus disease 2019 (COVID-19). The aim of this study was to describe the pattern of RRI in relation to AKI in patients with COVID-19 treated in the intensive care unit.Methods: In this observational cohort study, RRI was measured in COVID-19 patients in six ICUs at two sites of a Swedish University Hospital. AKI was defined by the creatinine criteria in the Kidney Disease Improving Global Outcome classification. We investigated the association between RRI and AKI diagnosis, different AKI stages and urine output.Results: RRI was measured in 51 patients, of which 23 patients (45%) had AKI at the time of measurement. Median RRI in patients with AKI was 0.80 (IQR 0.71-0.85) compared to 0.72 (IQR 0.67-0.78) in patients without AKI (p=0.004). Compared to patients without AKI, RRI was higher in patients with AKI stage 3 (median 0.83, IQR 0.71-0.85, p=0.006) but not in patients with AKI stage 1 (median 0.76, IQR 0.71-0.83, p=0.347) or AKI stage 2 (median 0.79, min/max 0.79/0.80, n=2, p=0.134). RRI was higher in patients with an ongoing AKI episode compared to patients who never developed AKI (median 0.72, IQR 0.69-0.78, p=0.015) or patients who developed AKI but had recovered at the time of measurement (median 0.68, IQR 0.67-0.81, p=0.021). Oliguric patients had higher RRI (median 0.84, IQR 0.83-0.85) compared to non-oliguric patients (median 0.74, IQR 0.69-0.81) (p=0.009).Conclusions: Critically ill COVID-19 patients with AKI have higher RRI compared to those without AKI, and elevated RRI may have a role in identifying severe and oliguric AKI in these patients.

scholarly journals Intensive care unit physician-delivered point of care renal tract ultrasound in acute kidney injury is feasible

2018 ◽  
Vol 19 (4) ◽  
pp. 313-318 ◽  
Author(s):  
Prashant Parulekar ◽  
Ed Neil-Gallacher ◽  
Alex Harrison
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Kidney Injury ◽  
Diagnostic Quality ◽  
The Core ◽  
Low Incidence

Acute kidney injury is common in critically ill patients, with ultrasound recommended to exclude renal tract obstruction. Intensive care unit clinicians are skilled in acquiring and interpreting ultrasound examinations. Intensive Care Medicine Trainees wish to learn renal tract ultrasound. We sought to demonstrate that intensive care unit clinicians can competently perform renal tract ultrasound on critically ill patients. Thirty patients with acute kidney injury were scanned by two intensive care unit physicians using a standard intensive care unit ultrasound machine. The archived images were reviewed by a Radiologist for adequacy and diagnostic quality. In 28 of 30 patients both kidneys were identified. Adequate archived images of both kidneys each in two planes were possible in 23 of 30 patients. The commonest reason for failure was dressings and drains from abdominal surgery. Only one patient had hydronephrosis. Our results suggest that intensive care unit clinicians can provide focussed renal tract ultrasound. The low incidence of hydronephrosis has implications for delivering the Core Ultrasound in Intensive Care competencies.

scholarly journals SAT-150 ACUTE KIDNEY INJURY IN CRITICALLY ILL PATIENTS IN A SOUTH AFRICAN TERTIARY INTENSIVE CARE UNIT

2019 ◽  
Vol 4 (7) ◽  
pp. S68
Author(s):  
R. AYLWARD ◽  
M. van Niekerk ◽  
D. Baker ◽  
J. Ensor ◽  
S. Pazi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
South African ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury

scholarly journals Nursing Activities Score and Acute Kidney Injury

2017 ◽  
Vol 70 (3) ◽  
pp. 475-480 ◽  
Author(s):  
Filipe Utuari de Andrade Coelho ◽  
Mirian Watanabe ◽  
Cassiane Dezoti da Fonseca ◽  
Katia Grillo Padilha ◽  
Maria de Fátima Fernandes Vattimo
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Kidney Disease ◽  
Quantitative Study ◽  
Kidney Injury ◽  
Nursing Workload ◽  
Intensive Care Patients ◽  
Stage 1

ABSTRACT Objective: to evaluate the nursing workload in intensive care patients with acute kidney injury (AKI). Method: A quantitative study, conducted in an intensive care unit, from April to August of 2015. The Nursing Activities Score (NAS) and Kidney Disease Improving Global Outcomes (KDIGO) were used to measure nursing workload and to classify the stage of AKI, respectively. Results: A total of 190 patients were included. Patients who developed AKI (44.2%) had higher NAS when compared to those without AKI (43.7% vs 40.7%), p <0.001. Patients with stage 1, 2 and 3 AKI showed higher NAS than those without AKI. A relationship was identified between stage 2 and 3 with those without AKI (p = 0.002 and p <0.001). Conclusion: The NAS was associated with the presence of AKI, the score increased with the progression of the stages, and it was associated with AKI, stage 2 and 3.

scholarly journals Nephrotoxic drug burden among 1001 critically ill patients: impact on acute kidney injury

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Stephan Ehrmann ◽  
◽  
Julie Helms ◽  
Aurélie Joret ◽  
Laurent Martin-Lefevre ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Drug Prescription ◽  
Kidney Injury ◽  
Simplified Acute Physiology Score ◽  
Severity Of Disease ◽  
Lower Severity

Abstract Background Nephrotoxic drug prescription may contribute to acute kidney injury (AKI) occurrence and worsening among critically ill patients and thus to associated morbidity and mortality. The objectives of this study were to describe nephrotoxic drug prescription in a large intensive-care unit cohort and, through a case–control study nested in the prospective cohort, to evaluate the link of nephrotoxic prescription burden with AKI. Results Six hundred and seventeen patients (62%) received at least one nephrotoxic drug, among which 303 (30%) received two or more. AKI was observed in 609 patients (61%). A total of 351 patients were considered as cases developing or worsening AKI a given index day during the first week in the intensive-care unit. Three hundred and twenty-seven pairs of cases and controls (patients not developing or worsening AKI during the first week in the intensive-care unit, alive the case index day) matched on age, chronic kidney disease, and simplified acute physiology score 2 were analyzed. The nephrotoxic burden prior to the index day was measured in drug.days: each drug and each day of therapy increasing the burden by 1 drug.day. This represents a semi-quantitative evaluation of drug exposure, potentially easy to implement by clinicians. Nephrotoxic burden was significantly higher among cases than controls: odds ratio 1.20 and 95% confidence interval 1.04–1.38. Sensitivity analysis showed that this association between nephrotoxic drug prescription in the intensive-care unit and AKI was predominant among the patients with lower severity of disease (simplified acute physiology score 2 below 48). Conclusions The frequently observed prescription of nephrotoxic drugs to critically ill patients may be evaluated semi-quantitatively through computing drug.day nephrotoxic burden, an index significantly associated with subsequent AKI occurrence, and worsening among patients with lower severity of disease.

scholarly journals 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

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.

Plasma cystatin C versus renal resistive index as early predictors of acute kidney injury in critically ill neonates

2020 ◽  
Vol 16 (2) ◽  
pp. 206.e1-206.e8
Author(s):  
Akram E. El-sadek ◽  
Mohamed A. El-Gamasy ◽  
Eman G. Behiry ◽  
Ahmed A. Torky ◽  
Mohamed A. Fathy
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Cystatin C ◽  
Resistive Index ◽  
Kidney Injury ◽  
Renal Resistive Index ◽  
Early Predictors ◽  
Critically Ill Neonates

scholarly journals Acute Kidney Injury Outcomes of Elderly and Nonelderly Patients in the Medical Intensive Care Unit of a University Hospital in a Developing Country

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Wanjak Pongsittisak ◽  
Kashane Phonsawang ◽  
Solos Jaturapisanukul ◽  
Surazee Prommool ◽  
Sathit Kurathong
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Medical Intensive Care Unit ◽  
Kidney Injury ◽  
The Elderly ◽  
University Hospital ◽  
Medical Intensive Care

Background. Aging is associated with a high risk of acute kidney injury (AKI), and the elderly with AKI show a higher mortality rate than those without AKI. In this study, we compared AKI outcomes between elderly and nonelderly patients in a university hospital in a developing country. Materials and Methods. This retrospective cohort study included patients with AKI who were admitted to the medical intensive care unit (ICU) between January 1, 2012, and December 31, 2017. The patients were divided into the elderly (eAKI; age ≥65 years; n = 158) and nonelderly (nAKI; n = 142) groups. Baseline characteristics, comorbidities, principle diagnosis, renal replacement therapy (RRT) requirement, hospital course, and in-hospital mortality were recorded. The primary outcome was in-hospital mortality. Results. The eAKI group included more females, patients with higher Acute Physiology and Chronic Health Evaluation II scores, and patients with more comorbidities than the nAKI group. The etiology and staging of AKI were similar between the two groups. There were no significant differences in in-hospital mortality (p=0.338) and RRT requirement (p=0.802) between the two groups. After adjusting for covariates, the 28-day mortality rate was similar between the two groups (p=0.654), but the 28-day RRT requirement was higher in the eAKI group than in the nAKI group (p=0.042). Conclusion. Elderly and nonelderly ICU patients showed similar survival outcomes of AKI, although the elderly were at a higher risk of requiring RRT.

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