Intensive Care Medicine

, Volume 37, Issue 1, pp 68–76

Diagnostic accuracy of Doppler renal resistive index for reversibility of acute kidney injury in critically ill patients

  • Michael Darmon
  • Frédérique Schortgen
  • Frederic Vargas
  • Aissam Liazydi
  • Benoît Schlemmer
  • Christian Brun-Buisson
  • Laurent Brochard
Original

DOI: 10.1007/s00134-010-2050-y

Cite this article as:
Darmon, M., Schortgen, F., Vargas, F. et al. Intensive Care Med (2011) 37: 68. doi:10.1007/s00134-010-2050-y

Abstract

Objectives

Diagnosing persistent acute kidney injury (AKI) as opposed to transient AKI in critically ill patients may help physicians in making treatment decisions. This diagnosis relies chiefly on urinary indices, which may be of limited value or difficult to obtain. We assessed the performance of the Doppler renal resistive index (RI) in diagnosing persistent AKI.

Design

Prospective observational study.

Setting

Twenty-four-bed medical intensive care unit in a university hospital.

Patients

Consecutive patients requiring mechanical ventilation, without severe chronic renal dysfunction or receiving diuretic therapy.

Definitions

Persistent AKI was defined as AKI lasting longer than 3 days. AKI resolving within 3 days in a patient with a cause of renal hypoperfusion was considered to be transient AKI. Results are reported as median values with interquartile range (IQR).

Measurements and main results

Of the 51 patients enrolled in the study, 16 had no AKI, 13 had transient AKI, and 22 had persistent AKI. The RI was 0.71 (0.66–0.77) in the no-AKI group, 0.71 (0.62–0.77) in the transient AKI group, and 0.82 (0.80–0.89) in the persistent AKI group (P < 0.0001). The RI was better than urinary indices for diagnosing persistent AKI. The area under the RI ROC curve was 0.91 [95% confidence interval (95% CI) 0.83–0.99; P < 0.0001]. An RI > 0.795 had a 92% sensitivity and 85% specificity for persistent AKI. Logistic regression analysis revealed that an RI > 0.795 [odds ratio (OR) 28.2; 95% CI 4.0–198] and a higher logistic organ dysfunction score (OR 1.85/point; 95% CI 1.20–2.85) predicted persistent AKI.

Conclusion

These preliminary results suggest that Doppler renal RI may be a promising tool for predicting the reversibility of AKI in critically ill patients.

Keywords

Kidney failureAcuteIntensive care unitsDopplerMechanical ventilationSensitivitySpecificity

Abbreviations

AKI

Acute kidney injury

ICU

Intensive care unit

MV

Mechanical ventilation

RI

Doppler-based renal resistive index

Supplementary material

134_2010_2050_MOESM1_ESM.docx (213 kb)
Supplementary material 1 (DOCX 212 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Michael Darmon
    • 2
    • 3
    • 4
    • 6
    • 7
  • Frédérique Schortgen
    • 1
    • 3
  • Frederic Vargas
    • 1
    • 3
  • Aissam Liazydi
    • 2
    • 3
  • Benoît Schlemmer
    • 4
    • 5
  • Christian Brun-Buisson
    • 1
    • 2
    • 3
  • Laurent Brochard
    • 1
    • 2
    • 3
  1. 1.Medical Intensive Care Unit, Centre hospitalier Albert Chenevier-Henri Mondor Assistance Publique des Hôpitaux de Paris (AP-HP)CréteilFrance
  2. 2.Université Paris-Est CréteilCréteilFrance
  3. 3.INSERM Unit 955CréteilFrance
  4. 4.Medical Intensive Care Unit, Saint-Louis University HospitalAssistance Publique des Hôpitaux de ParisParisFrance
  5. 5.Paris-7 Paris-Diderot UniversityParisFrance
  6. 6.Medical ICUSaint-Etienne University Hospital and Saint-Etienne Medical SchoolSaint-EtienneFrance
  7. 7.Thrombosis Research Group, EA 3065Saint-Etienne University Hospital and Saint-Etienne Medical SchoolSaint-EtienneFrance