Pre-procedural renal resistive index accurately predicts contrast-induced acute kidney injury in patients with preserved renal function submitted to coronary angiography

Abstract

The study aimed to evaluate the clinical utility of ultrasonographic intra-renal blood flow parameters, together with the wide range of different risk factors, for the prediction of contrast-induced acute kidney injury (CI-AKI) in patients with preserved renal function, referred for coronary angiography or percutaneous coronary interventions (CA/PCI). This prospective study covered 95 consecutive patients (69.5% men; median age 65 years) subject to elective or urgent CA/PCI. Data regarding 128 peri-procedural variables were collected. Ultrasonographic intra-renal blood flow parameters, including renal resistive index (RRI) and pulsatility index (RPI), were acquired directly before the procedure. CI-AKI was defined as ≥50% relative or ≥0.3 mg/dL absolute increase of serum creatinine 48 h after procedure. CI-AKI was confirmed in nine patients (9.5%). Patients with CI-AKI had higher SYNTAX score (p = 0.0002), higher rate of left main disease (p < 0.00001), peripheral artery disease (PAD; p = 0.02), coronary artery anomaly (p = 0.017), more frequently underwent surgical revascularization (p = 0.0003), ‘had greater...’ intima-(p = 0.004) and extra-medial thickness (p = 0.001), and received higher contrast media dose (p = 0.049), more often overused non-steroidal anti-inflammatory drugs (p = 0.001), and had substantially higher pre-procedural RRI (0.69 vs. 0.62; p = 0.005) and RPI values (1.54 vs. 1.36; p = 0.017). Logistic regression confirmed age, SYNTAX score, presence of PAD, diabetes mellitus, and pre-procedural RRI independently predicted CI-AKI onset (AUC = 0.95; p < 0.0001). Pre-procedural RRI > 0.69 had 78% sensitivity and 81% specificity in CI-AKI prediction. High pre-procedural RRI seems to be a useful novel risk factor for CI-AKI in patients with preserved renal function. Coronary, peripheral and renal vascular pathology contribute to the development of CI-AKI following CA/PCI.

Renal resistive index as an early predictor and discriminator of acute kidney injury in critically ill patients; A prospective observational cohort study

“…We included a mixed intensive care population with a high proportion of shock patients. Previous studies included other populations: major thoracic or orthopedic surgery [ 27 , 40 , 43 , 48 , 49 ], coronary angiography with contrast [ 51 ], mechanical ventilation [ 28 ], and septic shock [ 21 ]. One study evaluated the RRI in patients who had already developed AKI or prerenal azotemia [ 49 ].…”

Increased circulating galectin-1 levels are associated with the progression of kidney function decline in patients undergoing coronary angiography

“…Doppler evaluation 8 , 24-h serum creatinine elevation 9 , and renal injury biomarkers [10][11][12][13][14] . However, no predictive marker for long-term renal outcomes in patients undergoing CAG has been established.…”

Prediction of contrast‐induced acute kidney injury by early post‐procedural analysis of urinary biomarkers and intra‐renal Doppler flow indices in patients undergoing coronary angiography

“…The clinical value of post‐procedural RRI gains further importance in the context of its positive correlation with SYNTAX score (Figure S1) and EMT, and negative correlation with baseline LVEF. As shown before, RRI could represent an indicator of diffuse arterial stiffness and cardiovascular risk factor, predicting long‐term morbidity and mortality …”

“…The increased intra‐renal vascular resistance is predominantly manifested in direct vasa recta, but it may also extend to arcuate and interlobular arteries . Intra‐renal Doppler flow parameters, most notably renal resistive index (RRI), reflect intra‐renal hemodynamics and were shown to predict the onset and persistence of acute kidney injury, as well as in‐hospital mortality in intensive care setting . Early estimation of RRI following contrast agent administration has not been assessed so far for the prediction of CI‐AKI.…”