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      Ultrasonographic Intraparenchymal Renal Resistive Index Variation for Assessing Renal Functional Reserve in Patients Scheduled for Cardiac Surgery: A Pilot Study


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          Introduction: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common complication in patients undergoing cardiac surgery. Preoperative renal functional reserve (RFR) has been demonstrated to be highly predictive of CSA-AKI. We have previously demonstrated that intraparenchymal renal resistive index variation (IRRIV) measured by ultrasound (US) can identify the presence of RFR in healthy individuals. This study aimed (1) to examine the correlation between the US IRRIV test and RFR measured through the protein loading test in patients undergoing elective cardiac surgery and (2) to determine the value of the 2 methods for predicting occurrence of AKI or subclinical AKI after cardiac surgery. Methods: Consecutive patients scheduled for cardiac surgery were enrolled for this pilot study. The protein loading test and the IRRIV test were performed in all patients 2 days before cardiac surgery. Correlation between IRRIV and RFR was tested using Pearson correlation analysis. Association between presence of RFR and positive IRRIV test, presence of RFR and AKI and subclinical AKI, and positive IRRIV test and AKI and subclinical AKI was evaluated using logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the values of IRRIV for predicting RFR, RFR for predicting AKI and subclinical AKI, and IRRIV for predicting AKI and subclinical AKI. Results: Among the 31 patients enrolled, significant association was found between IRRIV and RFR ( r = 0.81; 95% CI: 0.63–0.90; p < 0.01). The association between RFR and IRRIV was described in 27/31 (87.1%) patients. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the IRRIV test were 100, 84, 60, and 100%, respectively. In ROC curve analysis, the area under the curve (AUC) was 0.80 (95% CI: 0.64–0.96). After cardiac surgery, 1/31 (3.2%) patient had AKI and 12/31 (38.7%) had subclinical AKI. RFR predicted subclinical AKI (odds ratio [OR] = 0.93; 95% CI: 0.87–0.98; p = 0.02). The sensitivity, specificity, PPV, and NPV of the RFR were 61, 88.8, 80, and 76%, respectively; the AUC was 0.75 (95% CI: 0.59–0.91). IRRIV predicts subclinical AKI (OR = 0.79; 95% CI: 0.67–0.93; p = 0.005). The sensitivity, specificity, PPV, and NPV of the IRRIV test were 46.1, 100, 100, and 72%, respectively; the AUC was 0.73 (95% CI: 0.58–0.87). Conclusion: This pilot study suggests that a positive IRRIV test can significantly predict the presence of RFR in patients scheduled for cardiac surgery. RFR measured by the protein loading test or by the US IRRIV test can predict the occurrence of subclinical postoperative AKI. The findings of this study need to be confirmed in large patient cohorts.

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                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                February 2022
                27 May 2021
                : 51
                : 2
                : 147-154
                [_a] aDepartment of Nephrology and Dialysis, ASST Lariana, S. Anna Hospital, Como, Italy
                [_b] bDepartment of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
                [_c] cDepartment of Anesthesia and Intensive Care, San Bortolo Hospital, Vicenza, Italy
                [_d] dDepartment of Internal Medicine II, Division of Nephrology, Pulmonology and Critical Care Medicine, University Hospital Giessen and Marburg, Giessen, Germany
                [_e] eDepartment of Translational Medicine, Nephrology and Kidney Transplantation Unit, University of Piemonte Orientale, “Maggiore della Carità” University Hospital, Novara, Italy
                [_f] fDepartment of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
                [_g] gDepartment of Nephrology, Dialysis and Transplantation and International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
                [_h] hDepartment of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padua, Padua, Italy
                [_i] iInstitute of Life Sciences, Sant’Anna School of Advanced Studies, Pisa, Italy
                [_j] jDepartment of Medicine (DIMED), University of Padua, Padua, Italy
                Author information
                516438 Blood Purif 2022;51:147–154
                © 2021 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                : 14 January 2021
                : 09 April 2021
                Page count
                Figures: 1, Tables: 3, Pages: 8
                Research Article

                Cardiovascular Medicine,Nephrology
                Renal functional reserve,Renal resistive index,Acute kidney injury,Cardiac surgery,Intraparenchymal renal resistive index variation test


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