The following is a summary of “Association between intrarenal venous flow from Doppler ultrasonography and acute kidney injury in patients with sepsis in critical care: a prospective, exploratory observational study,” published in the July 2023 issue of Critical Care by Fujii et al.
Doppler renal ultrasonography allows real-time visualization of intrarenal venous flow (IRVF) patterns, which can detect renal congestion during sepsis resuscitation.
Researchers performed a retrospective study investigating the relationship between IRVF patterns, clinical parameters, and outcomes in critically ill adult sepsis patients. They hypothesized that discontinuous IRVF is linked to high central venous pressure (CVP) and subsequent acute kidney injury (AKI) or death. The study was conducted in two tertiary-care hospitals involving ICU sepsis patients with central venous catheters and mechanical ventilation. A blinded assessor performed Renal ultrasonography after 24 hours to determine IRVF patterns (discontinuous vs. continuous). The primary outcome was CVP at the time of ultrasonography, while secondary outcomes included a composite of Stage 3 AKI or death over a week. Student’s t-test analyzed the association between IRVF patterns and CVP, and a generalized estimating equation analysis assessed the association with composite outcomes. The sample size was 32 to detect a 5-mmHg difference in CVP between IRVF patterns.
Of the 38 eligible patients, 22 (57.9%) exhibited discontinuous IRVF patterns indicating reduced renal venous flow. There was no significant association between IRVF patterns and CVP (discontinuous flow: mean 9.24 cm H2O [SD: 3.19], continuous flow: 10.65 cm H2O [SD: 2.53], p = 0.154). However, the incidence of the composite outcome was significantly higher in the discontinuous IRVF pattern group (odds ratio: 9.67; 95% CI: 2.13-44.03, P= 0.003).
The study concluded that IRVF patterns were associated with subsequent AKI in sepsis, not CVP.