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Open Access 01-10-2012 | Research

Doppler resistive index to reflect regulation of renal vascular tone during sepsis and acute kidney injury

Authors: Antoine Dewitte, Julien Coquin, Bertrand Meyssignac, Olivier Joannès-Boyau, Catherine Fleureau, Hadrien Roze, Jean Ripoche, Gérard Janvier, Christian Combe, Alexandre Ouattara

Published in: Critical Care | Issue 5/2012

Abstract

Introduction

Renal resistive index (RI), determined by Doppler ultrasonography, directly reveals and quantifies modifications in renal vascular resistance. The aim of this study was to evaluate if mean arterial pressure (MAP) is determinant of renal RI in septic, critically ill patients suffering or not from acute kidney injury (AKI).

Methods

This prospective observational study included 96 patients. AKI was defined according to RIFLE criteria and transient or persistent AKI according to renal recovery within 3 days.

Results

Median renal RIs were 0.72 (0.68-0.75) in patients without AKI and 0.76 (0.72-0.80) in patients with AKI (P=0.001). RIs were 0.75 (0.72-0.79) in transient AKI and 0.77 (0.70-0.80) in persistent AKI (P=0.84). RI did not differ in patients given norepinephrine infusion and was not correlated with norepinephrine dose. RI was correlated with MAP (ρ= -0.47; P=0.002), PaO₂/FiO₂ ratio (ρ= -0.33; P=0.04) and age (ρ=0.35; P=0.015) only in patients without AKI.

Conclusions

A poor correlation between renal RI and MAP, age, or PaO₂/FiO₂ ratio was found in septic and critically ill patients without AKI compared to patients with AKI. These findings suggest that determinants of RI are multiple. Renal circulatory response to sepsis estimated by Doppler ultrasonography cannot reliably be predicted simply from changes in systemic hemodynamics. As many factors influence its value, the interest in a single RI measurement at ICU admission to determine optimal MAP remains uncertain.

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de Mendonca A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, Takala J, Sprung C, Cantraine F: Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive Care Med 2000, 26: 915-921. 10.1007/s001340051281CrossRefPubMed

Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C, Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators: Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005, 294: 813-818. 10.1001/jama.294.7.813CrossRefPubMed

Sutton TA, Fisher CJ, Molitoris BA: Microvascular endothelial injury and dysfunction during ischemic acute renal failure. Kidney Int 2002, 62: 1539-1549. 10.1046/j.1523-1755.2002.00631.xCrossRefPubMed

Brady HR, Singer GG: Acute renal failure. Lancet 1995, 346: 1533-1540. 10.1016/S0140-6736(95)92057-9CrossRefPubMed

Antonelli M, Azoulay E, Bonten M, Chastre J, Citerio G, Conti G, De Backer D, Gerlach H, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Pugin J, Wernerman J, Zhang H: Year in review in Intensive Care Medicine 2010: I. Acute renal failure, outcome, risk assessment and ICU performance, sepsis, neuro intensive care and experimentals. Intensive Care Med 2011, 37: 19-34. 10.1007/s00134-010-2112-1PubMedCentralCrossRefPubMed

Lerolle N, Nochy D, Guerot E, Bruneval P, Fagon JY, Diehl JL, Hill G: Histopathology of septic shock induced acute kidney injury: apoptosis and leukocytic infiltration. Intensive Care Med 2010, 36: 471-478. 10.1007/s00134-009-1723-xCrossRefPubMed

Lameire N, Van Biesen W, Vanholder R: Acute renal failure. Lancet 2005, 365: 417-430.CrossRefPubMed

Schrier RW, Wang W: Acute renal failure and sepsis. N Engl J Med 2004, 351: 159-169. 10.1056/NEJMra032401CrossRefPubMed

Langenberg C, Wan L, Egi M, May CN, Bellomo R: Renal blood flow and function during recovery from experimental septic acute kidney injury. Intensive Care Med 2007, 33: 1614-1618. 10.1007/s00134-007-0734-8CrossRefPubMed

10.

Langenberg C, Wan L, Egi M, May CN, Bellomo R: Renal blood flow in experimental septic acute renal failure. Kidney Int 2006, 69: 1996-2002. 10.1038/sj.ki.5000440CrossRefPubMed

11.

Deruddre S, Cheisson G, Mazoit JX, Vicaut E, Benhamou D, Duranteau J: Renal arterial resistance in septic shock: effects of increasing mean arterial pressure with norepinephrine on the renal resistive index assessed with Doppler ultrasonography. Intensive Care Med 2007, 33: 1557-1562. 10.1007/s00134-007-0665-4CrossRefPubMed

12.

Darmon M, Schortgen F, Vargas F, Liazydi A, Schlemmer B, Brun-Buisson C, Brochard L: Diagnostic accuracy of Doppler renal resistive index for reversibility of acute kidney injury in critically ill patients. Intensive Care Med 2011, 37: 68-76. 10.1007/s00134-010-2050-yCrossRefPubMed

13.

Lerolle N, Guerot E, Faisy C, Bornstain C, Diehl JL, Fagon JY: Renal failure in septic shock: predictive value of Doppler-based renal arterial resistive index. Intensive Care Med 2006, 32: 1553-1559. 10.1007/s00134-006-0360-xCrossRefPubMed

14.

Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992, 101: 1644-1655. 10.1378/chest.101.6.1644CrossRefPubMed

15.

Payen JF, Bru O, Bosson JL, Lagrasta A, Novel E, Deschaux I, Lavagne P, Jacquot C: Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 2001, 29: 2258-2263. 10.1097/00003246-200112000-00004CrossRefPubMed

16.

Riker RR, Fraser GL, Cox PM: Continuous infusion of haloperidol controls agitation in critically ill patients. Crit Care Med 1994, 22: 433-440. 10.1097/00003246-199403000-00013CrossRefPubMed

17.

Vignon P: Hemodynamic assessment of critically ill patients using echocardiography Doppler. Curr Opin Crit Care 2005, 11: 227-234. 10.1097/01.ccx.0000159946.89658.51CrossRefPubMed

18.

Himmelfarb J, Joannidis M, Molitoris B, Schietz M, Okusa MD, Warnock D, Laghi F, Goldstein SL, Prielipp R, Parikh CR, Pannu N, Lobo SM, Shah S, D'Intini V, Kellum JA: Evaluation and initial management of acute kidney injury. Clin J Am Soc Nephrol 2008, 3: 962-967. 10.2215/CJN.04971107PubMedCentralCrossRefPubMed

19.

Nickolas TL, O'Rourke MJ, Yang J, Sise ME, Canetta PA, Barasch N, Buchen C, Khan F, Mori K, Giglio J, Devarajan P, Barasch J: Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Ann Intern Med 2008, 148: 810-819.PubMedCentralCrossRefPubMed

20.

Coca SG, King JT Jr, Rosenthal RA, Perkal MF, Parikh CR: The duration of postoperative acute kidney injury is an additional parameter predicting long-term survival in diabetic veterans. Kidney Int 2010, 78: 926-933. 10.1038/ki.2010.259PubMedCentralCrossRefPubMed

21.

Brown JR, Kramer RS, Coca SG, Parikh CR: Duration of acute kidney injury impacts long-term survival after cardiac surgery. Ann Thorac Surg 2010, 90: 1142-1148. 10.1016/j.athoracsur.2010.04.039CrossRefPubMed

22.

Shrout PE, Fleiss JL: Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979, 86: 420-428.CrossRefPubMed

23.

Langenberg C, Bellomo R, May C, Wan L, Egi M, Morgera S: Renal blood flow in sepsis. Crit Care 2005, 9: 363-374.CrossRef

24.

Parker MM, Shelhamer JH, Natanson C, Alling DW, Parrillo JE: Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: heart rate as an early predictor of prognosis. Crit Care Med 1987, 15: 923-929. 10.1097/00003246-198710000-00006CrossRefPubMed

25.

Villazon SA, Sierra UA, Lopez SF, Rolando MA: Hemodynamic patterns in shock and critically ill patients. Crit Care Med 1975, 3: 215-221. 10.1097/00003246-197511000-00002CrossRefPubMed

26.

Dellinger RP, Carlet JM, Masur H, Gerlach H, Calandra T, Cohen J, Gea-Banacloche J, Keh D, Marshall JC, Parker MM, Ramsay G, Zimmerman JL, Vincent JL, Levy MM, Surviving Sepsis Campaign Management Guidelines Committee: Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004, 32: 858-873. 10.1097/01.CCM.0000117317.18092.E4CrossRefPubMed

27.

Joannidis M, Druml W, Forni LG, Groeneveld AB, Honore P, Oudemans-van Straaten HM, Ronco C, Schetz MR, Woittiez AJ: Prevention of acute kidney injury and protection of renal function in the intensive care unit. Expert opinion of the Working Group for Nephrology, ESICM. Intensive Care Med 2010, 36: 392-411. 10.1007/s00134-009-1678-yCrossRefPubMed

28.

Darmon M, Schortgen F, Leon R, Moutereau S, Mayaux J, Di Marco F, Devaquet J, Brun-Buisson C, Brochard L: Impact of mild hypoxemia on renal function and renal resistive index during mechanical ventilation. Intensive Care Med 2009, 35: 1031-1038. 10.1007/s00134-008-1372-5CrossRefPubMed

29.

Benes J, Chvojka J, Sykora R, Radej J, Krouzecky A, Novak I, Matejovic M: Searching for mechanisms that matter in early septic acute kidney injury: an experimental study. Crit Care 2011, 15: R256. 10.1186/cc10517PubMedCentralCrossRefPubMed

Title: Doppler resistive index to reflect regulation of renal vascular tone during sepsis and acute kidney injury
Authors: Antoine Dewitte
Julien Coquin
Bertrand Meyssignac
Olivier Joannès-Boyau
Catherine Fleureau
Hadrien Roze
Jean Ripoche
Gérard Janvier
Christian Combe
Alexandre Ouattara
Publication date: 01-10-2012
Publisher: BioMed Central
Published in: Critical Care / Issue 5/2012
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc11517

At a glance: The STEP trials

Springer Medicine

Doppler resistive index to reflect regulation of renal vascular tone during sepsis and acute kidney injury

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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