Renal Resistive Index as a Predictor of Acute Kidney Injury and Mortality in COVID-19 Critically Ill Patients

Abstract

<b><i>Background:</i></b> Acute kidney injury (AKI) in patients with COVID-19 can be caused by multiple mechanisms. Renal resistive index (RRI) is a noninvasive instrument to evaluate kidney hemodynamics, and it is obtained by analysis of intrarenal arterial waves using Doppler ultrasound. This study aimed to determine the role of RRI in predicting AKI and adverse outcomes in critically ill patients with COVID-19. <b><i>Methods:</i></b> This cross-sectional study included 65 patients with confirmed SARS-CoV-2 pneumonia admitted to the critical care unit from April 1, 2020, to June 20, 2020. Informed consent was obtained from all individual participants included in the study. Cardiac, pulmonary, and kidney ultrasonographic evaluations were performed in a protocolized way. <b><i>Results:</i></b> In this cohort, 65 patients were included, mean age was 53.4 years, 79% were male, and 35% were diabetic. Thirty-four percent of patients developed AKI, 12% required RRT, and 35% died. Of the patients who developed AKI, 68% had RRI ≥ 0.7. Also, 75% of the patients who required RRT had RRI ≥ 0.7. In the adjusted Cox model, the RRI ≥ 0.7 was associated with higher mortality (HR 2.86, 95% CI: 1.19–6.82, <i>p</i> = 0.01). <b><i>Conclusions:</i></b> Critical care ultrasonography is a noninvasive, reproducible, and accurate bedside method that has proven its usefulness. An elevated RRI may have a role in predicting AKI, RRT initiation, and mortality in patients with severe SARS-CoV-2 pneumonia.

Assessing the venous system: Correlation of mean systemic filling pressure with the venous excess ultrasound grading system in cardiac surgery

“…It is also important to note that our study replicates the findings of an increased risk of developing acute kidney injury and increased total days of hospitalization, as reported in previous studies in other populations 17,19 …”

“…It is also important to note that our study replicates the findings of an increased risk of developing acute kidney injury and increased total days of hospitalization, as reported in previous studies in other populations. 17,19 We believe that the Pmsf, rather than constituting a predictor of fluid responsiveness, could constitute a limit to continue fluid resuscitation (in conjunction with other clinical tools), since there are no clinical studies to date evaluating its variation during fluid resuscitation (compared with a gold standard). Regarding the admission value (median of 18 mmHg) of the Pmsf, It is in similar ranges to those reported in studies of cardiac surgery and sepsis (9).…”

Renal Sonographic Indices as Predictive Markers for Acute Kidney Injury in Critical Care Patients: A Case Study of COVID-19 Patients

“…Similar to our ndings, a signi cant difference was observed, indicating that patients with RI values above 0.7 had a higher incidence of AKI. Additionally, out of the 65 patients, 23 died, and the mortality rate was signi cantly higher in patients with RI > 0.7 compared to those with RI < 0.7 (21). A systematic review conducted in 2020, similar to our research, demonstrated a signi cant difference in renal artery RI between the group with acute kidney failure and the group without kidney failure.…”

In Silico Prediction of Hub Genes Involved in Diabetic Kidney and COVID-19 Related Disease by Differential Gene Expression and Interactome Analysis

“…These medical literature points out that patients with both pathologies (DKD and COVID-19) develop multiple pathophysiological mechanisms between the lung and kidney organs. For instance, the SARS-CoV-2 infection relies on angiotensin-converting enzyme 2 as an input receptor for tubular epithelial and lung epithelial cells [ 10 , 11 ].…”