Rajaraman Balaji, Darlong Vanlal, Soni Kapil Dev, Aggarwal Richa, Dehran Maya, Devasenathipathy K, Trikha Anjan, Baidya Dalim Kumar
Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
J Clin Monit Comput. 2025 Aug;39(4):757-765. doi: 10.1007/s10877-025-01309-8. Epub 2025 Jun 12.
Renal Doppler ultrasonography may have an important role in the detection of acute kidney injury (AKI) in early stages. This study was aimed to determine whether renal Doppler parameters at day 1 can predict the development of AKI at day 5 in acute circulatory failure (ACF). After ethics committee approval and informed written consent from patients or legally acceptable representatives, we recruited n = 80 critically ill adult patients with ACF in this single-center, prospective observational study. Baseline demographic, clinical, and laboratory parameters were noted. Renal resistive index (RRI), power Doppler ultrasound (PDU) score, and their ratio (RRI/PDU) were measured at baseline and three consecutive days. The primary outcome was the development of AKI at day five, and the secondary outcomes were 28-day mortality, length of ICU stay, duration of ventilation, and vasopressor-free days. Out of 80 patients, n = 32 (40%) developed AKI. At baseline, fluid balance (ml/kg) and APACHE II score were higher and pH was lower in AKI group. RRI and RRI/PDU values were significantly higher, and PDU was significantly lower in the AKI group compared to the non-AKI group from day 1 to day 3. Moreover, changes in these parameters (ΔPDU and ΔRRI/PDU at day 2 and day 3) were significantly more in the AKI group. On regression analysis, all three Doppler parameters from day 1 to day 3 demonstrated very good to excellent accuracy in predicting the development of AKI. To conclude, renal Doppler parameters (RRI, PDU, and RRI/PDU) on day 1 through day 3 can predict the development of AKI by day 5 in critically ill adults with acute circulatory failure.
肾脏多普勒超声检查在急性肾损伤（AKI）的早期检测中可能发挥重要作用。本研究旨在确定急性循环衰竭（ACF）患者第1天的肾脏多普勒参数是否能够预测第5天AKI的发生。经伦理委员会批准并获得患者或法定认可代表的书面知情同意后，我们在这项单中心前瞻性观察性研究中招募了n = 80例患有ACF的危重症成年患者。记录了基线人口统计学、临床和实验室参数。在基线及连续三天测量肾脏阻力指数（RRI）、能量多普勒超声（PDU）评分及其比值（RRI/PDU）。主要结局是第5天AKI的发生，次要结局是28天死亡率、ICU住院时间、机械通气时间和无血管活性药物使用天数。80例患者中，n = 32例（40%）发生了AKI。在基线时，AKI组的液体平衡（ml/kg）和急性生理与慢性健康状况评分系统II（APACHE II）评分较高，pH值较低。从第1天到第3天，与非AKI组相比，AKI组的RRI和RRI/PDU值显著更高，而PDU显著更低。此外，这些参数的变化（第2天和第3天的ΔPDU和ΔRRI/PDU）在AKI组中显著更大。回归分析显示，第1天到第3天的所有三个多普勒参数在预测AKI的发生方面都具有非常好到极好的准确性。总之，第1天至第3天的肾脏多普勒参数（RRI、PDU和RRI/PDU）可以预测急性循环衰竭的危重症成年患者到第5天时AKI的发生。
