RENAL RESISTIVE INDEX (RRI) GUIDED BY ULTRASOUND (USG) AS A DIAGNOSTIC PREDICTOR OF ACUTE KIDNEY INJURY IN SEPSIS PATIENTS

Authors

  • Satria Pinanditas S Department of Anesthesiology, Pain Management, and Intensive Care, Udayana University, Sanglah General Hospital Bali
  • Putu Agus Surya Panji Department of Anesthesiology, Pain Management, and Intensive Care, Udayana University, Sanglah General Hospital Bali
  • I Made Gede Widnyana Department of Anesthesiology, Pain Management, and Intensive Care, Udayana University, Sanglah General Hospital Bali
  • I Wayan Suranadi Department of Anesthesiology, Pain Management, and Intensive Care, Udayana University, Sanglah General Hospital Bali
  • Tjahya Aryasa EM Department of Anesthesiology, Pain Management, and Intensive Care, Udayana University, Sanglah General Hospital Bali
  • I Made Agus Kresna Sucandra Department of Anesthesiology, Pain Management, and Intensive Care, Udayana University, Sanglah General Hospital Bali
  • Made Wiryana Department of Anesthesiology, Pain Management, and Intensive Care, Udayana University, Sanglah General Hospital Bali
  • Tjokorda Gde Agung Senapathi Department of Anesthesiology, Pain Management, and Intensive Care, Udayana University, Sanglah General Hospital Bali

DOI:

https://doi.org/10.31004/prepotif.v8i1.27245

Keywords:

acute kidney injury (AKI, diagnostic, renal resistive index (RRI), sepsis, ultrasound

Abstract

This study is an observational analytical study with a cross-sectional design conducted in the intensive care unit of RSUP Prof. Dr. I.G.N.G. Ngoerah from January 2024 until completion. The study population consisted of patients aged 18-65 years who met the criteria for sepsis diagnosis without chronic kidney disease. Data analysis was performed using SPSS version 26, including descriptive analysis, ROC curve, diagnostic test, and correlation analysis. The mean RRI at 0 hours was ±SB 0.78±0.68 cm/s for the AKI group and ±SB 0.60±0.08 cm/s for the non-AKI group. The mean RRI at 6 hours was ±SB 0.77±0.65 cm/s for the AKI group and ±SB 0.60±0.08 cm/s for the non-AKI group. The cut-off point for RRI at 0 hours was ?0.70 cm/s, with a sensitivity of 84.6%, specificity of 88.9%, accuracy of 86.4%, PPV of 91.7%, and NPV of 80%, with a relative risk of AKI of 4.58 times (95% CI 1.89-11.10; P<0.001). Meanwhile, for RRI at 6 hours, the cut-off point was also ?0.70 cm/s, with a sensitivity of 88.5%, specificity of 88.9%, accuracy of 88.6%, PPV of 92%, NPV of 84.2%, and a relative risk of AKI of 5.83 times (95% CI 2.05-16.56; P<0.001). The correlation coefficient between RRI at 0 hours and serum creatinine was r=0.380, p=0.011, while for RRI at 6 hours, it was r=0.393, p=0.008. RRI at 0 hours showed a correlation with urine production with r=-0.428, p=0.004, while for RRI at 6 hours, it was r=-0.540, p<0.001. In conclusion, RRI guided by ultrasound is a good diagnostic predictor for acute kidney injury in sepsis.

References

Bellos, I., Pergialiotis, V., & Kontzoglou, K. (2019). Renal resistive index as predictor of acute kidney injury after major surgery: A systematic review and meta-analysis. Journal of Critical Care, 50, 36–43. https://doi.org/10.1016/j.jcrc.2018.11.001

Beloncle, F., Rousseau, N., Hamel, J.-F., Donzeau, A., Foucher, A.-L., Custaud, M.-A., Asfar, P., Robert, R., & Lerolle, N. (2019). Determinants of Doppler-based renal resistive index in patients with septic shock: Impact of hemodynamic parameters, acute kidney injury and predisposing factors. Annals of Intensive Care, 9(1), 51. https://doi.org/10.1186/s13613-019-0525-8

Cherry, A. D., Hauck, J. N., Andrew, B. Y., Li, Y.-J., Privratsky, J. R., Kartha, L. D., Nicoara, A., Thompson, A., Mathew, J. P., & Stafford-Smith, M. (2020). Intraoperative renal resistive index threshold as an acute kidney injury biomarker. Journal of Clinical Anesthesia, 61, 109626. https://doi.org/10.1016/j.jclinane.2019.109626

Endre, Z. H., Pickering, J. W., & Walker, R. J. (2011). Clearance and beyond: The complementary roles of GFR measurement and injury biomarkers in acute kidney injury (AKI). American Journal of Physiology-Renal Physiology, 301(4), F697–F707. https://doi.org/10.1152/ajprenal.00448.2010

Gameiro, J., Agapito Fonseca, J., Jorge, S., & Lopes, J. A. (2018). Acute Kidney Injury Definition and Diagnosis: A Narrative Review. Journal of Clinical Medicine, 7(10), Article 10. https://doi.org/10.3390/jcm7100307

Hendra, M., Yun, A., & Widodo, U. (2023). Faktor Risiko Mortalitas Pasien Geriatri Yang Dirawat Di ICU RSUP dr. Sardjito Yogyakarta. Jurnal Komplikasi Anestesi, 10(2), Article 2. https://doi.org/10.22146/jka.v10i2.8306

Hotchkiss, R. S., Moldawer, L. L., Opal, S. M., Reinhart, K., Turnbull, I. R., & Vincent, J.-L. (2016). Sepsis and septic shock. Nature Reviews Disease Primers, 2(1), 1–21. https://doi.org/10.1038/nrdp.2016.45

Jonny, J., Hasyim, M., Angelia, V., Jahya, A. N., Hilman, L. P., Kusumaningrum, V. F., & Srisawat, N. (2020). Incidence of acute kidney injury and use of renal replacement therapy in intensive care unit patients in Indonesia. BMC Nephrology, 21(1), 191. https://doi.org/10.1186/s12882-020-01849-y

Kellum, J. A., Romagnani, P., Ashuntantang, G., Ronco, C., Zarbock, A., & Anders, H.-J. (2021). Acute kidney injury. Nature Reviews Disease Primers, 7(1), 1–17. https://doi.org/10.1038/s41572-021-00284-z

Liu, J., Xie, H., Ye, Z., Li, F., & Wang, L. (2020). Rates, predictors, and mortality of sepsis-associated acute kidney injury: A systematic review and meta-analysis. BMC Nephrology, 21(1), 318. https://doi.org/10.1186/s12882-020-01974-8

Luo, X., Jiang, L., Du, B., Wen, Y., Wang, M., Xi, X., & The Beijing Acute Kidney Injury Trial (BAKIT) workgroup. (2014). A comparison of different diagnostic criteria of acute kidney injury in critically ill patients. Critical Care, 18(4), R144. https://doi.org/10.1186/cc13977

Manrique-Caballero, C. L., Rio-Pertuz, G. D., & Gomez, H. (2021). Sepsis-Associated Acute Kidney Injury. Critical Care Clinics, 37(2), 279–301. https://doi.org/10.1016/j.ccc.2020.11.010

Mulier, J. L. G. H., Rozemeijer, S., Röttgering, J. G., Man, A. M. E. S., Elbers, P. W. G., Tuinman, P. R., Waard, M. C. de, & Straaten, H. M. O. (2018). Renal resistive index as an early predictor and discriminator of acute kidney injury in critically ill patients; A prospective observational cohort study. PLOS ONE, 13(6), e0197967. https://doi.org/10.1371/journal.pone.0197967

Peerapornratana, S., Manrique-Caballero, C. L., Gómez, H., & Kellum, J. A. (2019). Acute kidney injury from sepsis: Current concepts, epidemiology, pathophysiology, prevention and treatment. Kidney International, 96(5), 1083–1099. https://doi.org/10.1016/j.kint.2019.05.026

Setiawan, D., Harun, H., Azmi, S., & Priyono, D. (2018). Biomarker Acute Kidney Injury (AKI) pada Sepsis. Jurnal Kesehatan Andalas, 7(0), Article 0. https://doi.org/10.25077/jka.v7i0.838

Spatola, L., & Andrulli, S. (2016). Doppler ultrasound in kidney diseases: A key parameter in clinical long-term follow-up. Journal of Ultrasound, 19(4), 243–250. https://doi.org/10.1007/s40477-016-0201-x

Srisawat, N., Kulvichit, W., Mahamitra, N., Hurst, C., Praditpornsilpa, K., Lumlertgul, N., Chuasuwan, A., Trongtrakul, K., Tasnarong, A., Champunot, R., Bhurayanontachai, R., Kongwibulwut, M., Chatkaew, P., Oranrigsupak, P., Sukmark, T., Panaput, T., Laohacharoenyot, N., Surasit, K., Keobounma, T., … SEA-AKI study group. (2020). The epidemiology and characteristics of acute kidney injury in the Southeast Asia intensive care unit: A prospective multicentre study. Nephrology Dialysis Transplantation, 35(10), 1729–1738. https://doi.org/10.1093/ndt/gfz087

Srzi?, I., Nesek Adam, V., & Tunji? Pejak, D. (2022). Definicija sepse: Što je novo u smjernicama za lije?enje. Acta Clinica Croatica, 61(Supplement 1), 67–72.

Zhou, J., Bai, Y., Wang, X., Yang, J., Fu, P., Cai, D., & Yang, L. (2019). A simple risk score for prediction of sepsis associated-acute kidney injury in critically ill patients. Journal of Nephrology, 32(6), 947–956. https://doi.org/10.1007/s40620-019-00625-y

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Published

2024-04-30

How to Cite

Satria Pinanditas S, Putu Agus Surya Panji, I Made Gede Widnyana, I Wayan Suranadi, Tjahya Aryasa EM, I Made Agus Kresna Sucandra, Made Wiryana, & Tjokorda Gde Agung Senapathi. (2024). RENAL RESISTIVE INDEX (RRI) GUIDED BY ULTRASOUND (USG) AS A DIAGNOSTIC PREDICTOR OF ACUTE KIDNEY INJURY IN SEPSIS PATIENTS. PREPOTIF : JURNAL KESEHATAN MASYARAKAT, 8(1), 2482–2491. https://doi.org/10.31004/prepotif.v8i1.27245

Issue

Vol. 8 No. 1 (2024): APRIL 2024

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Articles

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Copyright (c) 2024 Satria Pinanditas S, Putu Agus Surya Panji, I Made Gede Widnyana, I Wayan Suranadi, Tjahya Aryasa EM, I Made Agus Kresna Sucandra, Made Wiryana, Tjokorda Gde Agung Senapathi

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