Renal resistive index is associated with acute kidney injury in COVID-19 patients treated in the intensive care unit

Mårten Renberg, Olof Jonmarker, Naima Kilhamn, Claire Rimes-Stigare, Max Bell, Daniel Hertzberg, Mårten Renberg, Olof Jonmarker, Naima Kilhamn, Claire Rimes-Stigare, Max Bell, Daniel Hertzberg

Abstract

Background: Renal resistive index (RRI) is a promising tool for the assessment of acute kidney injury (AKI) in critically ill patients in general, but its role and association to AKI among patients with Coronavirus disease 2019 (COVID-19) is not known.

Objective: The aim of this study was to describe the pattern of RRI in relation to AKI in patients with COVID-19 treated in the intensive care unit.

Methods: In this observational cohort study, RRI was measured in COVID-19 patients in six intensive care units at two sites of a Swedish University Hospital. AKI was defined by the creatinine criteria in the Kidney Disease Improving Global Outcomes classification. We investigated the association between RRI and AKI diagnosis, different AKI stages and urine output.

Results: RRI was measured in 51 patients, of which 23 patients (45%) had AKI at the time of measurement. Median RRI in patients with AKI was 0.80 (IQR 0.71-0.85) compared to 0.72 (IQR 0.67-0.78) in patients without AKI (p = 0.004). Compared to patients without AKI, RRI was higher in patients with AKI stage 3 (median 0.83, IQR 0.71-0.85, p = 0.006) but not in patients with AKI stage 1 (median 0.76, IQR 0.71-0.83, p = 0.347) or AKI stage 2 (median 0.79, min/max 0.79/0.80, n = 2, p = 0.134). RRI was higher in patients with an ongoing AKI episode compared to patients who never developed AKI (median 0.72, IQR 0.69-0.78, p = 0.015) or patients who developed AKI but had recovered at the time of measurement (median 0.68, IQR 0.67-0.81, p = 0.021). Oliguric patients had higher RRI (median 0.84, IQR 0.83-0.85) compared to non-oliguric patients (median 0.74, IQR 0.69-0.81) (p = 0.009). After multivariable adjustment, RRI was independently associated with AKI (OR for 0.01 increments of RRI 1.22, 95% CI 1.07-1.41).

Conclusions: Critically ill COVID-19 patients with AKI have higher RRI compared to those without AKI, and elevated RRI may have a role in identifying severe and oliguric AKI at the bedside in these patients.

Keywords: Acute kidney injury; COVID-19; Point-of-care ultrasound; Renal Doppler; Renal resistive index; Ultrasonography.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Selection of the study population. ICU, intensive care unit; ECMO, extracorporeal membrane oxygenation. a Not accessible due to ongoing resuscitation, delirium/agitation, ongoing long period of mobilization/physiotherapy or unknown reason
Fig. 2
Fig. 2
Dot plot illustrating the association between renal resistive index and acute kidney injury (AKI) in patients with or without AKI (left) and patients with different stages of AKI (right). Each dot represents a patient. The horizontal lines represent the median, upper and lower quartiles
Fig. 3
Fig. 3
Dot plot illustrating the association between renal resistive index and acute kidney injury (AKI) in patients who did not develop AKI, developed AKI but recovered, and had an ongoing AKI episode at the time of measurement. Each dot represents a patient. The horizontal lines represent the median, upper and lower quartiles
Fig. 4
Fig. 4
Dot plot illustrating the association between renal resistive index and oliguria defined as urine output 

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