Abstract
Background
Renal resistive index (RRI) and renal pulsatility index (RPI) are Doppler-based variables proposed to assess renal perfusion at the bedside in critically ill patients. This study aimed to assess the accuracy of such variables to predict acute kidney injury (AKI) in mechanically ventilated children.
Methods
Consecutive children aged <14 years underwent kidney Doppler ultrasound examination within 24 h of invasive mechanical ventilation. Renal resistive index (RRI) and renal pulsatility index (RPI) were measured. The primary outcome was severe AKI (KDIGO stage 2 or 3) on day 3.
Results
On day 3, 22 patients were classified as having AKI, of which 12 were severe. RRI could effectively predict severe AKI (area under the ROC curve [AUC] = 0.94) as well as RPI (AUC = 0.86). The optimal cut-off for RRI was 0.85 (sensitivity, 91.7%; specificity, 84.7%; PPV, 50.0%; and NPV, 98.4%). Similar results were obtained when the accuracy to predict AKI on day 5 was assessed. Significant correlations were observed between RRI and estimated glomerular filtration rate at enrollment (ρ = −0.495) and on day 3 (ρ = −0.467).
Conclusions
Renal Doppler ultrasound may be a promising tool to predict AKI in critically ill children under invasive mechanical ventilation.
Impact
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Early recognition of acute kidney injury (AKI) is essential to promptly initiate supportive care aimed at restoring renal perfusion, which may prevent or attenuate acute tubular necrosis.
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Renal arterial Doppler-based parameters are rapid, noninvasive, and repeatable variables that may be promising for the prediction of AKI in children.
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To the best of our knowledge, this is the first study to evaluate the use of renal Doppler-based variables to predict AKI in critically ill children.
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The present study found that Doppler-based variables could accurately predict the occurrence of severe AKI and were correlated with urinary output and diuretic use.
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Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Acknowledgements
Thank you to Carolina Grotta Ramos Telio for her review of the manuscript. We also thank the legal guardians of the participants, attending physicians, pediatric critical care residents, and the nursing staff.
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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.
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Conception and design: T.H.d.S.; acquisition of data: A.V.d.C., I.S.F., F.M.d.S.; T.H.d.S.; analysis and interpretation of data: A.V.d.C., I.S.F., T.H.d.S.; drafting the article: A.V.d.C., I.S.F., T.H.d.S.; revising the article critically for important intellectual content: R.J.N.N., M.B.B., and D.F.S.A.; all of the authors read and approved the manuscript.
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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the UNICAMP’s Research and Ethics Committee, approval #44357421.7.0000.5404. Written informed consent was obtained from the parents.
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de Carvalho, A.V., Ferraz, I.d.S., de Souza, F.M. et al. Acute kidney injury in critically ill children: predictive value of renal arterial Doppler assessment. Pediatr Res 93, 1694–1700 (2023). https://doi.org/10.1038/s41390-022-02296-1
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DOI: https://doi.org/10.1038/s41390-022-02296-1
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