Abu-Naeima Eslam, Fatthy Moataz, Shalaby Mahmoud Amin Abu-Sheaishaa, Ayeldeen Ghada, Verbrugge Frederik H, Rola Philippe, Beaubien-Souligny William, Fayed Ahmed
Nephrology Unit, Internal Medicine Department, Kasr Al Ainy School of Medicine, Cairo University, Al Kasr Al Ainy, Old Cairo, Cairo Governorate, Cairo, 4240310, Egypt.
Cardiology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.
BMC Nephrol. 2025 Mar 27;26(1):157. doi: 10.1186/s12882-025-04060-z.
Cardiorenal syndrome poses significant diagnostic and therapeutic challenges. The Venous Excess Ultrasound (VExUS) grading system based on the combination of venous Doppler assessments has shown potential in predicting acute kidney injury and cardiovascular outcomes, but its relevance regarding the management of acutely decompensated heart failure (ADHF) remains to be fully understood.
In this prospective study, patients with ADHF and acute kidney injury (AKI) were enrolled from a medical intensive care unit over 20 months. The study involved echocardiography and VExUS grading at admission and 72 h later. Data collection included clinical parameters, diuretic dosages, urine output, and fluid balance. Statistical analyses focused on exploring the relationships between VExUS grades and its components, including the renal venous stasis index (RVSI), diuretic efficiency, and renal function improvement.
The cohort of 43 patients showed varied VExUS grades at admission. Higher VExUS grades were significantly associated with lower diuretic efficiency. Specifically, the mean urine output per 40 mg of furosemide was 368 ± 213 mL, with patients having VExUS grade 2 or 3 exhibiting reduced diuretic efficiency compared to those with grade 0-1 (Grade 2 vs. Grade 0-1: 333 ± 214 mL vs. 507 ± 189 mL, p = 0.02; Grade 3 vs. Grade 0-1: 270 ± 167 mL vs. 507 ± 189 mL, p = 0.004). The relationship between VExUS grade and diuretic efficiency was independent of admission creatinine and prior use of loop-diuretics (β = -106 CI: -180; -32 p = 0.006). Among the components of venous congestion assessment, the RVSI had the best ability to predict low diuretic efficiency (AUROC: 0.76 (0.60; 091) p = 0.001). Improvement in VExUS grade at 72 h was correlated with significant renal function improvement (84.6% vs. 47.1% for improved vs. non-improved VExUS grades, p = 0.03).
High VExUS and RVSI grades at admission are independently associated with reduced diuretic efficiency in ADHF patients with AKI. The findings emphasize the clinical value of venous congestion assessment in cardiorenal syndrome management including the selection of an initial diuretic dose.
心肾综合征带来了重大的诊断和治疗挑战。基于静脉多普勒评估组合的静脉淤血超声（VExUS）分级系统在预测急性肾损伤和心血管结局方面已显示出潜力，但其在急性失代偿性心力衰竭（ADHF）管理中的相关性仍有待充分了解。
在这项前瞻性研究中，在20个月内从医疗重症监护病房招募了患有ADHF和急性肾损伤（AKI）的患者。该研究包括入院时和72小时后的超声心动图和VExUS分级。数据收集包括临床参数、利尿剂剂量、尿量和液体平衡。统计分析重点在于探索VExUS分级与其组成部分之间的关系，包括肾静脉淤滞指数（RVSI）、利尿效率和肾功能改善情况。
43例患者队列在入院时显示出不同的VExUS分级。较高的VExUS分级与较低的利尿效率显著相关。具体而言，每40毫克呋塞米的平均尿量为368±213毫升，VExUS 2级或3级患者的利尿效率低于0 - 1级患者（2级与0 - 1级：333±214毫升对507±189毫升，p = 0.02；3级与0 - 1级：270±167毫升对507±189毫升，p = 0.004）。VExUS分级与利尿效率之间的关系独立于入院时的肌酐水平和先前使用袢利尿剂的情况（β = -106，CI：-180；-32，p = 0.006）。在静脉淤血评估的组成部分中，RVSI预测低利尿效率的能力最强（曲线下面积：0.76（0.60；0.91），p = 0.001）。72小时时VExUS分级的改善与显著的肾功能改善相关（VExUS分级改善组与未改善组分别为84.6%对47.1%，p = 0.03）。
入院时高VExUS和RVSI分级与AKI的ADHF患者利尿效率降低独立相关。这些发现强调了静脉淤血评估在包括初始利尿剂剂量选择的心肾综合征管理中的临床价值。
