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01-11-2018 | Original

Performance of Doppler-based resistive index and semi-quantitative renal perfusion in predicting persistent AKI: results of a prospective multicenter study

Authors: Michael Darmon, Aurelie Bourmaud, Marie Reynaud, Stéphane Rouleau, Ferhat Meziani, Alexandra Boivin, Mourad Benyamina, François Vincent, Alexandre Lautrette, Christophe Leroy, Yves Cohen, Matthieu Legrand, Jérôme Morel, Jeremy Terreaux, David Schnell

Published in: Intensive Care Medicine | Issue 11/2018

Abstract

Purpose

The Doppler-based resistive index (RI) and semi-quantitative evaluation of renal perfusion using color Doppler (SQP) have shown promising results for predicting persistent acute kidney injury (AKI) in preliminary studies. This study aimed at evaluating the performance of RI and SQP to predict short-term renal prognosis in critically ill patients.

Methods

Prospective multicenter cohort study including unselected critically ill patients. Renal Doppler was performed at admission to the intensive care unit. The diagnostic performance of RI and SQP to predict persistent AKI at day 3 was evaluated.

Results

Overall, 371 patients were included, of whom 351 could be assessed for short-term renal recovery. Two thirds of the included patients had AKI (n = 233; 66.3%), of whom 136 had persistent AKI (58.4%). Doppler-based RI was higher and SQP lower in AKI patients and according to AKI recovery. Overall performance in predicting persistent AKI was however poor with area under ROC curve of respectively 0.58 (95% CI 0.52–0.64) and 0.59 (95% CI 0.54–0.65) for RI and SQP. Optimal cutoff was respectively 0.71 and 2 for RI and SQP. At optimal cutoff, sensitivity and specificity were 50% (95% CI 41–58%) and 68% (62–74%) for RI and 39% (32–45%) and 75% (66–82%) for SQP.

Conclusion

Although statistically associated with AKI occurrence, RI and SQP perform poorly in predicting persistent AKI at day 3. Further studies are needed to adequately describe factors influencing Doppler-based assessment of renal perfusion and to delineate whether these indicators may be useful at the bedside.

Clinicaltrial.gov

NCT02355314.

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Prowle JR, Liu Y-L, Licari E, Bagshaw SM, Egi M, Haase M et al (2011) Oliguria as predictive biomarker of acute kidney injury in critically ill patients. Crit Care 15(4):R172CrossRef

Bagshaw SM (2008) Short- and long-term survival after acute kidney injury. Nephrol Dial Transplant 23(7):2126–2128CrossRef

Metnitz PGH, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K et al (2002) Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 30(9):2051–2058CrossRef

Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG et al (2007) Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11(2):R31CrossRef

Waikar SS, Bonventre JV (2009) Creatinine kinetics and the definition of acute kidney injury. J Am Soc Nephrol 20(3):672–679CrossRef

Kellum JA, Lameire N (2013) KDIGO AKI guideline work group. diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 17(1):204CrossRef

Darmon M, Schortgen F, Vargas F, Liazydi A, Schlemmer B, Brun-Buisson C et al (2011) Diagnostic accuracy of Doppler renal resistive index for reversibility of acute kidney injury in critically ill patients. Intensive Care Med 37(1):68–676CrossRef

Lerolle N, Guérot E, Faisy C, Bornstain C, Diehl J-L, Fagon J-Y (2006) Renal failure in septic shock: predictive value of Doppler-based renal arterial resistive index. Intensive Care Med 32(10):1553–1559CrossRef

Schnell D, Deruddre S, Harrois A, Pottecher J, Cosson C, Adoui N et al (2012) Renal resistive index better predicts the occurrence of acute kidney injury than cystatin C. Shock 38(6):592–597CrossRef

10.

Platt JF, Rubin JM, Ellis JH (1991) Acute renal failure: possible role of duplex Doppler US in distinction between acute prerenal failure and acute tubular necrosis. Radiology 179(2):419–423CrossRef

11.

Schnell D, Reynaud M, Venot M, Le Maho AL, Dinic M, Baulieu M et al (2014) Resistive Index or color-Doppler semi-quantitative evaluation of renal perfusion by inexperienced physicians: results of a pilot study. Minerva Anestesiol 80(12):1273–1281PubMed

12.

Dewitte A, Coquin J, Meyssignac B, Joannès-Boyau O, Fleureau C, Roze H et al (2012) Doppler resistive index to reflect regulation of renal vascular tone during sepsis and acute kidney injury. Crit Care 16(5):R165CrossRef

13.

Schnell D, Camous L, Guyomarc’h S, Duranteau J, Canet E, Gery P et al (2013) Renal perfusion assessment by renal Doppler during fluid challenge in sepsis. Crit Care Med 41(5):1214–1220CrossRef

14.

Ninet S, Schnell D, Dewitte A, Zeni F, Meziani F, Darmon M (2015) Doppler-based renal resistive index for prediction of renal dysfunction reversibility: a systematic review and meta-analysis. J Crit Care 30(3):629–635CrossRef

15.

Schnell D, Darmon M (2012) Renal Doppler to assess renal perfusion in the critically ill: a reappraisal. Intensive Care Med 38(11):1751–1760CrossRef

16.

Lerolle N (2012) Please don’t call me RI anymore; I may not be the one you think I am! Crit Care 16(6):174CrossRef

17.

Dewitte A, Joannès-Boyau O, Sidobre C, Fleureau C, Bats M-L, Derache P et al (2015) Kinetic eGFR and Novel AKI Biomarkers to predict renal recovery. Clin J Am Soc Nephrol 10(11):1900–1910CrossRef

18.

Kellum JA, Lameire N (2013) KDIGO AKI guideline work group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 17(1):204CrossRef

19.

Perinel S, Vincent F, Lautrette A, Dellamonica J, Mariat C, Zeni F et al (2015) Transient and persistent acute kidney injury and the risk of hospital mortality in critically ill patients: results of a multicenter cohort study. Crit Care Med 43(8):269–275CrossRef

20.

Chawla LS, Bellomo R, Bihorac A, Goldstein SL, Siew ED, Bagshaw SM et al (2017) Acute kidney disease and renal recovery: consensus report of the acute disease quality initiative (ADQI) 16 workgroup. Nat Rev Nephrol 13(4):241–257CrossRef

21.

Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A et al (1996) The logistic organ dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU scoring group. JAMA 276(10):802–810CrossRef

22.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13(10):818–829CrossRef

23.

Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D et al (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Intensive Care Med 29(4):530–538CrossRef

24.

Hajian-Tilaki K (2014) Sample size estimation in diagnostic test studies of biomedical informatics. J Biomed Inform 48:193–204CrossRef

25.

Vittinghoff E, McCulloch CE (2007) Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 165(6):710–718CrossRef

26.

DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44(3):837–845CrossRef

27.

Robin X, Turck N, Hainard A, Tiberti N, Lisacek F, Sanchez J-C et al (2011) pROC: an open-source package for R and S + to analyze and compare ROC curves. BMC Bioinform 17(12):77CrossRef

28.

Fawcett T (2006) An introduction to ROC analysis. Pattern Recogn Lett 27(8):861–874CrossRef

29.

Perkins NJ, Schisterman EF (2006) The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol 163(7):670–675CrossRef

30.

Kellum JA, Sileanu FE, Murugan R, Lucko N, Shaw AD, Clermont G (2015) Classifying AKI by urine output versus serum creatinine level. J Am Soc Nephrol 26(9):2231–2238CrossRef

31.

Izumi M, Sugiura T, Nakamura H, Nagatoya K, Imai E, Hori M (2000) Differential diagnosis of prerenal azotemia from acute tubular necrosis and prediction of recovery by Doppler ultrasound. Am J Kidney Dis 35(4):713–719CrossRef

32.

Stevens PE, Gwyther SJ, Hanson ME, Boultbee JE, Kox WJ, Phillips ME (1990) Noninvasive monitoring of renal blood flow characteristics during acute renal failure in man. Intensive Care Med 16(3):153–158CrossRef

33.

Tublin ME, Tessler FN, Murphy ME (1999) Correlation between renal vascular resistance, pulse pressure, and the resistive index in isolated perfused rabbit kidneys. Radiology 213(1):258–264CrossRef

34.

Bude RO, Rubin JM (1999) Relationship between the resistive index and vascular compliance and resistance. Radiology 211(2):411–417CrossRef

35.

Murphy ME, Tublin ME (2000) Understanding the Doppler RI: impact of renal arterial distensibility on the RI in a hydronephrotic ex vivo rabbit kidney model. J Ultrasound Med 19(5):303–314CrossRef

36.

Darmon M, Schortgen F, Leon R, Moutereau S, Mayaux J, Di Marco F et al (2009) Impact of mild hypoxemia on renal function and renal resistive index during mechanical ventilation. Intensive Care Med 35(6):1031–1038CrossRef

37.

Naesens M, Heylen L, Lerut E, Claes K, De Wever L, Claus F et al (2013) Intrarenal resistive index after renal transplantation. N Engl J Med 369(19):1797–1806CrossRef

38.

Cook NR (2007) Use and misuse of the receiver operating characteristic curve in risk prediction. Circulation 115(7):928–935CrossRef

39.

de Grooth H-J, Parienti J-J, Schetz M (2018) AKI biomarkers are poor discriminants for subsequent need for renal replacement therapy, but do not disqualify them yet. Intensive Care Med 44(7):1156–1158CrossRef

Title: Performance of Doppler-based resistive index and semi-quantitative renal perfusion in predicting persistent AKI: results of a prospective multicenter study
Authors: Michael Darmon
Aurelie Bourmaud
Marie Reynaud
Stéphane Rouleau
Ferhat Meziani
Alexandra Boivin
Mourad Benyamina
François Vincent
Alexandre Lautrette
Christophe Leroy
Yves Cohen
Matthieu Legrand
Jérôme Morel
Jeremy Terreaux
David Schnell
Publication date: 01-11-2018
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 11/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5386-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Performance of Doppler-based resistive index and semi-quantitative renal perfusion in predicting persistent AKI: results of a prospective multicenter study

Abstract

Purpose

Methods

Results

Conclusion

Clinicaltrial.gov

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Clinicaltrial.gov

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Correction to: White paper: statement on conflicts of interest