Renal resistance index during septic shock

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Published Feb 1, 2025
https://doi.org/10.62438/tunismed.v103i2.5020
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Vol. 103 No. 2 (2025): Tunis Med Feb 2025

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Mahmoud Marzouk
Department of Anaesthesia and Intensive Care, National Institute of Neurology of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
https://orcid.org/0000-0002-9326-1503
Aymen Adhoum
Department of Anaesthesia and Intensive Care, National Institute of Neurology of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Azza Ben Yedder
Department of Anaesthesia and Intensive Care, National Institute of Neurology of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Rabeb Hammami
Department of Anaesthesia and Intensive Care, National Institute of Neurology of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Saber Thamlaoui
Department of Anaesthesia and Intensive Care, National Institute of Neurology of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Nader Baffoun
Department of Anaesthesia and Intensive Care, National Institute of Neurology of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia

Abstract

Introduction: Acute kidney Injury (AKI) is the most frequent complication of septic shock. Bedside ultrasound measurement of the renal resistance index (RRI) is an interesting way of assessment of renal hemodynamics. 


Aims : To study the variability of RRI during septic shock and its correlation with the occurrence of AKI.


Methods: This is a prospective observational study including patients in septic shock and on mechanical ventilation. Data collection was carried out between October 2022 and July 2023. RRI was measured during the first five days of shock.


Results: Forty patients were enrolled in the study. Mean age was equal to 51 years ±13.4 and sex ratio was equal to 2.33. The mean RRI value was 0.704, with extremes ranging from 0.52 to 0.83. Patients were divided into two groups : AKI(+) and AKI (-). RRI in the group AKI (+) was higher than in the group AKI (-) (0.757 vs. 0.672; p=0.013). RRI predicted the occurrence of AKI, with an area under the ROC curve of 0.75 (p=0.007) and a cut-off value of 0.71 (specificity=64%, sensitivity=73%).


Conclusion: Assessment of RRI could be a useful technique of predicting the onset of AKI in association with the conventional markers. Its validation will guide management towards optimal renal protection in patients with septic shock.

Keywords:

Acute kidney injury , Creatinine , Septic shock, Diuresis , Ultrasound , Vascular resistance

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References

  1. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021 Nov;47(11):1181–247.
  2. Bauer M, Gerlach H, Vogelmann T, Preissing F, Stiefel J, Adam D. Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019: results from a systematic review and meta-analysis. Crit Care. 2020 Dec;24(1):239.
  3. Hoste EJ, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI- EPI study. Intensive Care Med. 2015 Aug;41(8):1411–23.
  4. Barbar SD, Clere-Jehl R, Bourredjem A, Hernu R, Montini F, Bruyère R, et al. Timing of renal-replacement therapy in patients with acute kidney injury and sepsis. N Engl J Med. 2018 Oct;379(15):1431–42.
  5. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012 Oct;120(4):179–184.
  6. Pickkers P, Darmon M, Hoste E, Joannidis M, Legrand M, Ostermann M, et al. Acute kidney injury in the critically ill: an updated review on pathophysiology and management. Intensive Care Med. 2021 Aug;47(8):835–50.
  7. Lerolle N. Utilisation de l’index de résistance vasculaire rénal mesuré par échographie Doppler au cours du choc septique. Reanimation. 2009 Dec;18(8):708–13.
  8. Sugiura T, Nakamori A, Wada A, Fukuhara Y. Evaluation of tubulointerstitial injury by Doppler ultrasonography in glomerular diseases. Clin Nephrol. 2004 Feb;61(2):119–26.
  9. Radermacher J, Mengel M, Ellis S, Stuht S, Hiss M, Schwarz A, et al. The renal arterial resistance index and renal allograft survival. N Engl J Med. 2003 Jul;349(2):115–24.
  10. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016 Feb;315(8):801–10.
  11. Behrendt P, Rohner P, Baumgartner RW. A validation study on the intraobserver and interobserver reproducibility of renal artery duplex ultrasound. Ultrasound Med Biol. 1999 Feb;25(2):225–31
  12. Dennen P, Douglas IS, Anderson R. Acute kidney injury in the intensive care unit: an update and primer for the intensivist. Crit Care Med. 2010 Jan;38(1):261–75.
  13. Aitken E, Carruthers C, Gall L, Kerr L, Geddes C, Kingsmore D. Acute kidney injury: outcomes and quality of care. QJM. 2013 Apr;106(4):323–32.
  14. De Geus H, Bakker J, Lesaffre E, Le Noble L. Neutrophil gelatinase-associated lipocalin at ICU admission predicts for acute kidney injury in adult patients. Am J Respir Crit Care Med. 2011 Apr;183(7):907–14.
  15. Kashani K, Al-Khafaji A, Ardiles T, Artigas A, Bagshaw SM, Bell M, et al. Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury. Crit Care. 2013 Feb;17(1):R25.
  16. Dewitte A, Coquin J, Meyssignac B, Joannès-Boyau O, Fleureau C, Roze H, et al. Doppler resistive index to reflect regulation of renal vascular tone during sepsis and acute kidney injury. Crit Care. 2012 Sep;16(5):R165.
  17. Himmelfarb J, Joannidis M, Molitoris B, Schietz M, Okusa MD, Warnock D, et al. Evaluation and initial management of acute kidney injury. Clin J Am Soc Nephrol. 2008 Jul;3(4):962–7.
  18. Kawai T, Kamide K, Onishi M, Yamamoto-Hanasaki H, Baba Y, Hongyo K, et al. Usefulness of the resistive index in renal Doppler ultrasonography as an indicator of vascular damage in patients with risks of atherosclerosis. Nephrol Dial Transplant. 2011 Oct;26(10):3256–62.
  19. Insalaco M, Zamboli P, Floccari F, Marrocco F, Andrulli S, Logias F, et al. Indication to renal biopsy in DM2 patients: potential role of intrarenal resistive index. Arch Ital Urol Androl. 2012 Dec;84(4):283–6.
  20. Lerolle N, Guérot 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 Sep;32(10):1553–9.
  21. Schnell D, Deruddre S, Harrois A, Pottecher J, Cosson C, Adoui N, et al. Renal resistive index better predicts the occurrence of acute kidney injury than cystatin C. Shock. 2012 Dec;38(6):592–7.
  22. Schnell D, Bourmaud A, Reynaud M, Rouleau S, Merdji H, Boivin A, et al. Performance of renal Doppler to predict the occurrence of acute kidney injury in patients without acute kidney injury at admission. J Crit Care. 2022 Jun;69:153983.
  23. Wiersema R, Kaufmann T, Van Der Veen HN, De Haas RJ, Franssen CFM, Koeze J, et al. Diagnostic accuracy of arterial and venous renal Doppler assessment for acute kidney injury in critically ill patients: a prospective study. J Crit Care. 2020 Oct;59:57–62.
  24. Yu A, Zhao Q, Qu Y, Liu G. Renal Doppler Ultrasound in the Evaluation of Renal Function in Patients with Sepsis. Appl Bionics Biomech. 2022 Apr;2022:1–8.
  25. Bossard G, Bourgoin P, Corbeau JJ, Huntzinger J, Beydon L. Early detection of postoperative acute kidney injury by Doppler renal resistive index in cardiac surgery with cardiopulmonary bypass. Br J Anaesth. 2011 Dec;107(6):891–8.
  26. Marty P, Ferre F, Labaste F, Jacques L, Luzi A, Conil JM, et al. The Doppler renal resistive index for early detection of acute kidney injury after hip fracture. Anaesth Crit Care Pain Med. 2016 Dec;35(6):377–82.
  27. Darmon M, Schortgen F, Vargas F, Liazydi A, Schlemmer B, Brun-Buisson C, et al. Diagnostic accuracy of Doppler renal resistive index for reversibility of acute kidney injury in critically ill patients. Intensive Care Med. 2011 Jan;37(1):68–76.
  28. Xing ZQ, Liu DW, Wang XT, Long Y, Zhang HM, Wang C, et al. The value of renal resistance index and urine oxygen pressure for prediction of acute kidney injury in patients with septic shock. Zhonghua Nei Ke Za Zhi. 2019 May;58(5):349–54.
  29. Beloncle F, Rousseau N, Hamel JF, Donzeau A, Foucher AL, Custaud MA, et al. Determinants of Doppler-based renal resistive index in patients with septic shock: impact of hemodynamic parameters, acute kidney injury and predisposing factors. Ann Intensive Care. 2019 Dec;9(1):51.
  30. Malhotra R, Kashani KB, Macedo E, Kim J, Bouchard J, Wynn S, et al. A risk prediction score for acute kidney injury in the intensive care unit. Nephrol Dial Transplant. 2017 May;32(5):814–22.