In emergency department patients requiring resuscitation room care, can Renal Resistive Index measurements predict the development of acute kidney injury?

  • Heather Venables

Student thesis: Doctoral ThesisDoctor of Health (DHealth)

Abstract

PURPOSE: Doppler renal resistive index (RRI) has emerged in the last decade as a useful prognostic indicator for transient (fluid responsive) and persistent acute kidney injury (AKI). The determinants of RRI are largely systemic and recent studies confirm that RRI measurement could also be a useful early marker for sub-clinical AKI and post procedural AKI risk. This study aimed to determine the feasibility of RRI measurement in an Emergency Department (ED) resuscitation room setting using a point­of­care ultrasound system.

METHODS: In this prospective single centre study, RRI measurement was attempted in 20 non-consecutive patients (meeting the inclusion criteria) by a single expert sonographer. RRI measurements were evaluated against context specific feasibility criteria and target outcomes.

RESULTS: 20 patients (11 male, 9 female) were recruited to the study. Age of patients ranged from 33 years to 91 years (mean 62.3 years). Adequate visualisation of both kidneys was achieved in 60% of patients (n=12). In patients where it was not possible to achieve adequate views of both kidneys (n=8), limiting technical factors were shortness of breath (SOB) (n=6), high BMI (n=2). At least one measurement of RRI was achieved in 70% of patients (n=14). However, in 9 of these patients (64.3%) the Doppler spectral traces achieved were substandard and did not meet the measurement criteria for RRI as specified in the study protocol. In 30% of patients (n=6) no usable spectral trace was achieved and it was not possible to measure RRI. SOB was noted as a technical difficulty in 60% of patients (n=12) including three for whom RRI measurements were achieved. In 9 patients (45%) SOB was recorded as the primary reason for failure to acquire a usable Doppler trace. All criteria for RRI measurements were met in only 3 patients (15%).

CONCLUSION:
Measurement of RRI was not feasible in patients requiring resuscitation room care using a current point of care ultrasound system. If RRI is to play a useful role in this high priority patient group, adaptation of the available technology is required to mitigate the problem of image blur due to patient breathing movement.


KEYWORDS: Acute kidney injury; Doppler; Resistive index; Feasibility; Emergency Department
Date of Award13 Feb 2019
LanguageEnglish
Awarding Institution
  • University of Bath
SupervisorManuchehr Soleimani (Supervisor) & Iain Lennon (Supervisor)

Keywords

  • Acute kidney injury
  • Doppler
  • Resistive index
  • feasibility
  • Emergency Department

Cite this

In emergency department patients requiring resuscitation room care, can Renal Resistive Index measurements predict the development of acute kidney injury?
Venables, H. (Author). 13 Feb 2019

Student thesis: Doctoral ThesisDoctor of Health (DHealth)