New renal haemodynamic indices can predict worsening of renal function in acute decompensated heart failure

Abstract

Aims Worsening of renal function (WRF) is a common complication in patients with acute decompensated heart failure (ADHF). We aimed to evaluate the role of intrarenal Doppler ultrasound (IRD) in the early prediction of WRF in this patient group. Methods and results Among 90 patients (age: 57.5 ± 11.1 years; 62% male) hospitalized with ADHF, resistivity index (RI), acceleration time (AT), and pulsatility index (PI) were measured on admission and at 24 and 72 h. WRF was defined as increased serum creatinine ≥0.3 mg/dL from baseline. Adverse clinical outcomes were defined as the composite of death, use of vasopressors, and need for ultrafiltration for refractory oedema. WRF developed in 40% of patients. Mean values of renal AT, RI, and PI on admission were 59.7 ± 15, 0.717 ± 0.08, and 1.5 ± 0.48 ms, respectively. At 24 h, there was significant decrease in AT (to 56.7 ± 10 ms, P = 0.02) and renal RI (to 0.732 ± 0.07; P < 0.001); these changes were maintained up to 72 h. Renal PI showed no significant changes. Independent predictors of WRF were renal AT at 24 h and admission values of renal RI, left ventricular ejection fraction, and plasma cystatin C. Renal AT at 24 h ≥ 57.8 ms had 89% sensitivity and 70% specificity for the prediction of WRF. Independent predictors for adverse clinical outcomes were left ventricular end systolic dimension and WRF. Conclusions Among ADHF patients receiving diuretic therapy, measurement of renal AT and RI by IRD can help identify patients at increased risk for WRF.

Current Insights into Renal Resistive Index Significance in Kidney and Cardiovascular Disease

“…In addition, patients with HF with preserved EF and subclinical renal impairment assessed by high RRI have an increased risk of cardiovascular major events and poor prognosis compared to those with normal renal function [119]. Furthermore, RRI and acceleration time measured at the time of hospitalization and after 24 hours are powerful predictors of worsening renal function in acute decompensated HF patients with 89% sensitivity and 70% specificity [120].…”

Transcending boundaries: Unleashing the potential of multi-organ point-of-care ultrasound in acute kidney injury

“…Renal arterial resistive index: In principle, the measurement of intra-renal arterial resistive index (RI) is an appealing method to assess renal perfusion, and it has been studied in various clinical scenarios such as heart failure, septic shock, and hepatorenal syndrome, showing some usefulness[ 40 - 43 ]. The RI is calculated using the formula (peak systolic velocity-end diastolic velocity)/peak systolic velocity within a given cardiac cycle (Figure 4A ).…”

Continuous renal replacement therapy under special conditions like sepsis, burn, cardiac failure, neurotrauma, and liver failure

“…Some preliminary studies are showing the interest of intrarenal Doppler ultrasound for detecting early worsening of renal function, but again, we do need large RCTs to address this issue better. 71…”