Bedside Doppler ultrasound for the assessment of renal perfusion in the ICU: advantages and limitations of the available techniques

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Abstract

Three Doppler-derived techniques have been proposed to assess renal perfusion at bedside: Doppler-based renal resistive index (RI) which has been extensively but imperfectly studied in assessing renal allograft status and changes in renal perfusion in critically ill patients and for predicting the reversibility of an acute kidney injury (AKI), semi-quantitative evaluation of renal perfusion using colour-Doppler which may be easier to perform and may give similar information than RI and contrast-enhanced sonography that may allow more precise renal and cortical perfusion assessment. These promising tools have several obvious advantages including their feasibility, non-invasiveness, repeatability and potential interest in assessing renal function or perfusion. However, several limits need to be taken into account with these techniques, and promising results remain associated with large areas of uncertainty. This editorial will describe more carefully advantages and limits of these techniques and will discuss their potential interest in assessing renal perfusion.

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Most cited references 30

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Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study.

Sara Nisula, Kirsi-Maija Kaukonen, Suvi Vaara … (2013)

We aimed to determine the incidence, risk factors and outcome of acute kidney injury (AKI) in Finnish ICUs. This prospective, observational, multi-centre study comprised adult emergency admissions and elective patients whose stay exceeded 24 h during a 5-month period in 17 Finnish ICUs. We defined AKI first by the Acute Kidney Injury Network (AKIN) criteria supplemented with a baseline creatinine and second with the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We screened the patients' AKI status and risk factors for up to 5 days. We included 2,901 patients. The incidence (95 % confidence interval) of AKI was 39.3 % (37.5-41.1 %). The incidence was 17.2 % (15.8-18.6 %) for stage 1, 8.0 % (7.0-9.0 %) for stage 2 and 14.1 % (12.8-15.4 %) for stage 3 AKI. Of the 2,901 patients 296 [10.2 % (9.1-11.3 %)] received renal replacement therapy. We received an identical classification with the new KDIGO criteria. The population-based incidence (95 % CI) of ICU-treated AKI was 746 (717-774) per million population per year (reference population: 3,671,143, i.e. 85 % of the Finnish adult population). In logistic regression, pre-ICU hypovolaemia, diuretics, colloids and chronic kidney disease were independent risk factors for AKI. Hospital mortality (95 % CI) for AKI patients was 25.6 % (23.0-28.2 %) and the 90-day mortality for AKI patients was 33.7 % (30.9-36.5 %). All AKIN stages were independently associated with 90-day mortality. The incidence of AKI in the critically ill in Finland was comparable to previous large multi-centre ICU studies. Hospital mortality (26 %) in AKI patients appeared comparable to or lower than in other studies.

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Relationship between the resistive index and vascular compliance and resistance.

R Bude, J M Rubin (1999)

To evaluate the dependence of the resistive index (RI) on not only vascular resistance but also vascular compliance. An in vitro model that made use of a pulsatile pump, blood-mimicking fluid, and variable compliance and resistance was used to investigate the relationship between the RI and both vascular compliance and resistance. In the absence of vascular compliance, the RI was independent of vascular resistance. With vascular compliance, the RI was dependent on vascular resistance and increased with increasing resistance. The higher the compliance, the more the RI was affected by resistance. The RI is misnamed and should actually be called the "impedance index" because resistance and compliance interact to alter the Doppler arterial waveform. A greater understanding of this relationship may enable future studies that take both resistance and compliance into account to better detect pathologic conditions.

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The renal arterial resistance index and renal allograft survival.

Janice Ellis, Michael Burg, Ute Eisenberger … (2003)

Most renal transplants fail because of chronic allograft nephropathy or because the recipient dies, but no reliable factor predicting long-term outcome has been identified. We tested whether a renal arterial resistance index of less than 80 was predictive of long-term allograft survival. The renal segmental arterial resistance index (the percentage reduction of the end-diastolic flow as compared with the systolic flow) was measured by Doppler ultrasonography in 601 patients at least three months after transplantation between August 1997 and November 1998. All patients were followed for three or more years. The combined end point was a decrease of 50 percent or more in the creatinine clearance rate, allograft failure (indicated by the need for dialysis), or death. A total of 122 patients (20 percent) had a resistance index of 80 or higher. Eighty-four of these patients (69 percent) had a decrease of 50 percent or more in creatinine clearance, as compared with 56 of the 479 patients with a resistance index of less than 80 (12 percent); 57 patients with a higher resistance index (47 percent) required dialysis, as compared with 43 patients with a lower resistance index (9 percent); and 36 patients with a higher resistance index (30 percent) died, as compared with 33 patients with a lower resistance index (7 percent) (P<0.001 for all comparisons). A total of 107 patients with a higher resistance index (88 percent) reached the combined end point, as compared with 83 of those with a lower resistance index (17 percent, P<0.001). The multivariate relative risk of graft loss among patients with a higher resistance index was 9.1 (95 percent confidence interval, 6.6 to 12.7). Proteinuria (protein excretion, 1 g per day or more), symptomatic cytomegalovirus infection, and a creatinine clearance rate of less than 30 ml per minute per 1.73 m2 of body-surface area after transplantation also increased the risk. A renal arterial resistance index of 80 or higher measured at least three months after transplantation is associated with poor subsequent allograft performance and death. Copyright 2003 Massachusetts Medical Society

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Author and article information

Contributors

Michael Darmon: +33 477 12 78 53 , michael.darmon@chu-st-etienne.fr

Journal

Journal ID (nlm-ta): Crit Ultrasound J

Journal ID (iso-abbrev): Crit Ultrasound J

Title: Critical Ultrasound Journal

Publisher: Springer Milan (Milan )

ISSN (Print): 2036-3176

ISSN (Electronic): 2036-7902

Publication date (Electronic): 28 May 2015

Publication date PMC-release: 28 May 2015

Publication date Collection: 2015

Volume: 7

Electronic Location Identifier: 8

Affiliations

[ ]Medical-Surgical Intensive Care Unit, Angoulême Hospital, Angoulême, France

[ ]Medical-Surgical Intensive Care Unit, Saint-Etienne University Hospital, Avenue Albert Raimond, 42270 Saint-Priest-en-Jarez, Saint-Etienne France

[ ]Jacques Lisfranc Medical School, Jean Monnet University, Saint-Etienne, France

Article

Publisher ID: 24

DOI: 10.1186/s13089-015-0024-6

PMC ID: 4461647

PubMed ID: 26058500

SO-VID: 58ab6419-5f4c-4e22-95f9-63bcc8cd1221

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

History

Date received : 20 February 2015

Date accepted : 5 May 2015

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ScienceOpen disciplines: Radiology & Imaging

Keywords: acute kidney injury,resistive index,doppler,contrast-enhanced ultrasonography

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ScienceOpen disciplines: Radiology & Imaging

Keywords: acute kidney injury, resistive index, doppler, contrast-enhanced ultrasonography

Bedside Doppler ultrasound for the assessment of renal perfusion in the ICU: advantages and limitations of the available techniques

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Karger: Nephrology

Most cited references 30

Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study.

Relationship between the resistive index and vascular compliance and resistance.

The renal arterial resistance index and renal allograft survival.

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