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International Urology and Nephrology
Published in: International Urology and Nephrology 8/2016

01-08-2016 | Nephrology - Original Paper

Influence of volume administration on Doppler-based renal resistive index, renal hemodynamics and renal function in medical intensive care unit patients with septic-induced acute kidney injury: a pilot study

Authors: Tobias Lahmer, Sebastian Rasch, Christopher Schnappauf, Roland M. Schmid, Wolfgang Huber

Published in: International Urology and Nephrology | Issue 8/2016

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Abstract

Purpose

Impact of volume challenge (VC) on renal hemodynamics and renal function in patients with septic-induced acute kidney injury in addition to transpulmonary thermodilution (TPTD)-derived hemodynamic parameters.

Methods

Systemic hemodynamic parameters derived from TPTD, Doppler-based resistive index (RI) urine output, creatinine and urea levels were obtained before, after and 24 h after VC.

Results

Heart rate (p < 0.045), systolic blood pressure (p < 0.030) and mean arterial pressure (p < 0.001) were significantly altered after VC in VC responders compared to baseline immediately after VC but not after 24 h (p = 0.719; p = 0.576; p = 0.435).TPTD-derived cardiac function parameter cardiac index significantly increased after VC (p < 0.001) as well after 24 h (p < 0.02) in the responder group. Stroke volume index also significantly increased after VC (0.033) in responders immediately after VC, but not after 24 h of VC (p < 0.073). No significant changes could be observed in the non-responder group.Renal RI was not significantly different between VC responders and VC non-responders (p = 0.55) immediately after VC and after 24 h (p = 0.65).Creatinine levels in VC responders significantly decreased after 24 h (p < 0.001). Urine output increased from 400 to 542 ml/d in responders, but not statistically significant (p = 0.09). Vasopressor dose in VC responders was statistically significantly lower after 24 h (p < 0.001) compared to baseline.

Conclusions

Responders to VC with septic-induced AKI can benefit from an optimized hemodynamic environment. The resistive index to guide fluid therapy for renal hemodynamic management may be limited by the small magnitude of the changes.
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Metadata
Title
Influence of volume administration on Doppler-based renal resistive index, renal hemodynamics and renal function in medical intensive care unit patients with septic-induced acute kidney injury: a pilot study
Authors
Tobias Lahmer
Sebastian Rasch
Christopher Schnappauf
Roland M. Schmid
Wolfgang Huber
Publication date
01-08-2016
Publisher
Springer Netherlands
Published in
International Urology and Nephrology / Issue 8/2016
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI
https://doi.org/10.1007/s11255-016-1312-1

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