Influence of volume administration on Doppler-based renal resistive index, renal hemodynamics and renal function in medical intensive care unit patients with septic-induced acute kidney injury: a pilot study.

Lahmer, Tobias; Rasch, Sebastian; Schnappauf, Christopher; Schmid, Roland M; Huber, Wolfgang

doi:10.1007/s11255-016-1312-1

2016

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Title:: Influence of volume administration on Doppler-based renal resistive index, renal hemodynamics and renal function in medical intensive care unit patients with septic-induced acute kidney injury: a pilot study.
Document type:: Journal Article; 8
Author(s):: Lahmer, Tobias; Rasch, Sebastian; Schnappauf, Christopher; Schmid, Roland M; Huber, Wolfgang
Abstract:: Impact of volume challenge (VC) on renal hemodynamics and renal function in patients with septic-induced acute kidney injury in addition to transpulmonary thermodilution (TPTD)-derived hemodynamic parameters.Systemic hemodynamic parameters derived from TPTD, Doppler-based resistive index (RI) urine output, creatinine and urea levels were obtained before, after and 24 h after VC.Heart rate (p < 0.045), systolic blood pressure (p < 0.030) and mean arterial pressure (p < 0.001) were significantly altered after VC in VC responders compared to baseline immediately after VC but not after 24 h (p = 0.719; p = 0.576; p = 0.435).TPTD-derived cardiac function parameter cardiac index significantly increased after VC (p < 0.001) as well after 24 h (p < 0.02) in the responder group. Stroke volume index also significantly increased after VC (0.033) in responders immediately after VC, but not after 24 h of VC (p < 0.073). No significant changes could be observed in the non-responder group.Renal RI was not significantly different between VC responders and VC non-responders (p = 0.55) immediately after VC and after 24 h (p = 0.65).Creatinine levels in VC responders significantly decreased after 24 h (p < 0.001). Urine output increased from 400 to 542 ml/d in responders, but not statistically significant (p = 0.09). Vasopressor dose in VC responders was statistically significantly lower after 24 h (p < 0.001) compared to baseline.Responders to VC with septic-induced AKI can benefit from an optimized hemodynamic environment. The resistive index to guide fluid therapy for renal hemodynamic management may be limited by the small magnitude of the changes.
Journal title abbreviation:: Int Urol Nephrol
Year:: 2016
Journal volume:: 48
Journal issue:: 8
Pages contribution:: 1327-34
Language:: eng
Fulltext / DOI:: doi:10.1007/s11255-016-1312-1
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/27193438
Print-ISSN:: 0301-1623
TUM Institution:: II. Medizinische Klinik und Poliklinik (Gastroenterologie)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Innere Medizin II, Gastroenterologie (Prof. Schmid)2016