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

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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.

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Abbreviations

AKI:

Acute kidney injury

ICU:

Intensive care unit

MV:

Mechanical ventilation

RI:

Doppler-based renal resistive index

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Acknowledgments

We thank A. Wolfe MD for helping with this manuscript. Financial support consisted of a grant from the Assistance Publique-Hôpitaux de Paris (CRC 07 011), a nonprofit government-funded organization, and a grant from the French Society for Intensive Care (SRLF), a nonprofit learned society in France.

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Correspondence to Michael Darmon.

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Darmon, M., Schortgen, F., Vargas, F. et al. Diagnostic accuracy of Doppler renal resistive index for reversibility of acute kidney injury in critically ill patients. Intensive Care Med 37, 68–76 (2011). https://doi.org/10.1007/s00134-010-2050-y

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