Renal Resistive Index and mortality in critical patients with acute kidney injury

Boddi, Maria; Bonizzoli, Manuela; Chiostri, Marco; Begliomini, Dario; Molinaro, Adele; Buoninsegni, Laura Tadini; Gensini, Gian Franco; Peris, Adriano

doi:10.1111/eci.12590

Cited by 37 publications

(33 citation statements)

References 39 publications

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“…The prediction of AKI by RRI as measured with intraoperative trans-esophageal echocardiography, for patients undergoing cardiac surgery, is comparable to that obtained by RRI through translumbar ultrasound 89 . Elevated RRI is associated with AKI in orthopedic surgery and in critically ill patients in the medical ICU 90–92 . Renal resistive index has also been shown to be useful in predicting the progression of postoperative AKI 93 .…”

Section: Renal Resistive Indexmentioning

confidence: 99%

Perioperative Acute Kidney Injury

Hobson

Ruchi

2017

Critical Care Clinics

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Synopsis Acute kidney injury (AKI) is a common complication in the surgical patient and is associated with increases in mortality, an increased risk for chronic kidney disease (CKD) and hemodialysis after discharge, and increased cost. Better understanding of the risk factors that contribute to perioperative AKI has led to improved AKI prediction and will eventually lead to improved prevention of AKI, mitigation of injury when AKI occurs and enhanced recovery in patients who sustain AKI. The development of advanced clinical prediction scores for AKI, new imaging techniques and novel biomarkers for early detection of AKI provides new tools toward these ends.

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Section: Renal Resistive Indexmentioning

confidence: 99%

Perioperative Acute Kidney Injury

Hobson

Ruchi

2017

Critical Care Clinics

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“…Clinical characteristics of the study population have been previously described in detail . The study covered 95 patients with CAD (69.5% men; median age 65 [59; 71]).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 29.5% of the patients exhibited non‐ST‐elevation myocardial infarction. In brief, the population had high prevalence of obesity (41%), cigarette smoking (61%), diabetes mellitus or pre‐diabetic states (39%), arterial hypertension (96%), and hyperlipidemia (93%) . The population was characterized by low‐to‐moderate CI‐AKI risk with the Mehran risk score of 7.5% (7.5; 14).…”

Section: Resultsmentioning

confidence: 99%

“…This study is a part of a larger prospective investigation into the predictors of CI‐AKI. The study design has been described previously . Ninety‐five patients with CAD were enrolled for the study between 2013 and 2015 following the analysis of baseline clinical and laboratory data, prior to urgent or elective referral for CA/PCI.…”

Section: Methodsmentioning

confidence: 99%

“…The study covered consecutive patients with either: (i) stable angina with high pre‐test probability of CAD or ischemia confirmed using non‐invasive stress test; or (ii) non‐ST‐elevation acute coronary syndrome according to ESC NSTE‐ACS 2011 guidelines. Exclusion criteria comprised hemodynamic instability, acute and chronic respiratory failure, and several comorbidities potentially interfering with intra‐renal Doppler‐derived blood flow parameters, as well as contraindications to coronary angiography itself, such as active thyroid disease, pregnancy, or previous hypersensitivity to iodine containing contrast agents. Of note, subjects with chronic kidney disease (eGFR <50 mL/min/1.73 m 2 or proteinuria >500 mg/L or active urinary tract infection or renal artery stenosis) were also excluded from the analysis.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

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

Wybraniec

Chudek

Bożentowicz-Wikarek

et al. 2017

J Interven Cardiology

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Renal Ultrasound (and Doppler Sonography) in Hypertension: An Update

Boddi

2016

Advances in Experimental Medicine and Biology

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Ultrasound (US) allows the non-invasive evaluation of morphological changes of kidney structure (by means of B-Mode) and patterns of renal and extrarenal vascularization (by means of color-Doppler and contrast-enhanced US). In hypertensive subjects it offers a relevant contribution to the diagnosis of early renal damage, acute or chronic nephropathies and nephrovascular disease. However, morphological changes are often detected late and non-specific and in recent years evidence has increased regarding the clinical relevance of renal resistive index (RRI) for the study of vascular and renal parenchymal renal abnormalities. RRI is measured by Doppler sonography in an intrarenal artery, as the difference between the peak systolic and end-diastolic blood velocities divided by the peak systolic velocity. At first RRI was proved to be a marker of renal disease onset and progression; later the influence of systemic vascular properties on RRI was shown and authors claimed its use as an independent predictor of cardiovascular risk rather than of renal damage. Indeed, renal vascular resistance is only one of several renal (vascular compliance, interstitial and venous pressure), and extrarenal (heart rate, pulse pressure) determinants that concur to determine RRI individual values but not the most important one. The clinical relevance of RRI measurement as a surrogate endpoint of specific renal damage or/and as surrogate endpoint of atherosclerotic diffuse vascular damage is still debated.To summarize, from the literature: (a) In hypertensives with normal renal function and no albuminuria, especially in younger people, RRI is an early marker of renal damage that is especially useful when hypertension and diabetes concur in the same subjects. In these subjects RRI could improve current clinical scores used to stratify early renal damage. In older subjects RRI increases in accordance with the increase in systemic vascular stiffness and, because of this close relationship, RRI is also a marker of systemic atherosclerotic burden and the role of renal determinants can weaken. The clinical relevance was not specifically investigated. (b) In transplant kidney and in chronic renal disease high (>0.80) RRI values can independently predict renal failure. The recent claim that systemic (pulse pressure) rather than renal hemodynamic determinants sustain this predictive role of RRI, does not significantly reduce this predictive role of RRI. (c) Doppler ultrasound allows diagnosis and grading of renal stenosis in both fibromuscolar dysplastic and atherosclerotic diseases. Moreover, by RRI assay Doppler ultrasound can indirectly measure the hemodynamic impact of renal artery stenosis on the homolateral kidney, by virtue of the stenosis-related decrease in pulse pressure. However, in elderly subjects with atherosclerotic renal artery stenosis coexisting renal diseases can independently increase RRI by the augmentation in renal vascular stiffness and tubulo-interstitial pressure and hidden changes due to renal artery stenosis.

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Renal Resistive Index and mortality in critical patients with acute kidney injury

Abstract: High RRI values at AKI diagnosis are strictly and independently associated with in-ICU mortality and persistent AKI at ICU discharge.

Cited by 37 publications

References 39 publications

Perioperative Acute Kidney Injury

Perioperative Acute Kidney Injury

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

Renal Ultrasound (and Doppler Sonography) in Hypertension: An Update

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