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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

  • Nephrology - Original Paper
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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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Authors’ contribution

Tobias Lahmer (TL), Sebastian Rasch (SR), Christopher Schnappauf (CS), Roland M Schmid (RMS), Wolfgang Huber (WH) have contributed to this study. TL, CS, SR, RMS, WH studied the design. TL, CS, SR, WH collected data. TL, CS, SR, RMS, WH were involved in data analysis. TL, CS, SR, RMS, WH wrote the manuscript. Study is approved by the institutional review board of the Technical University of Munich, Germany. Written informed consent was obtained.

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Authors and Affiliations

  1. II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der, Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany

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

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  1. Tobias Lahmer
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  2. Sebastian Rasch
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  3. Christopher Schnappauf
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Correspondence to Tobias Lahmer.

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Conflict of interest

Wolfgang Huber collaborates with Pulsion Medical Systems SE (Feldkirchen, Germany) as member of the Medical Advisory Board. All other authors have no conflict of interest to disclose.

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Lahmer, T., Rasch, S., Schnappauf, C. et al. 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 . Int Urol Nephrol 48, 1327–1334 (2016). https://doi.org/10.1007/s11255-016-1312-1

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  • DOI: https://doi.org/10.1007/s11255-016-1312-1

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