Sarah N Fernández1,2,3,4, Jorge López5,6,7,8, Rafael González5,6,7,8, María J Solana5,6,7,8, Javier Urbano5,6,7,8, Alejandra Aguado9, Ángel Lancharro9, Jesús López-Herce5,6,7,8, María J Santiago5,6,7,8. 1. Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Calle O´Donnell 48, 28009, Madrid, Spain. sarahlafever@gmail.com. 2. School of Medicine, Complutense University of Madrid, Madrid, Spain. sarahlafever@gmail.com. 3. Gregorio Marañón Health Research Institute, Madrid, Spain. sarahlafever@gmail.com. 4. Research Network On Maternal and Child Health and Development (Red SAMID), Madrid, Spain. sarahlafever@gmail.com. 5. Pediatric Intensive Care Department, Gregorio Marañón General University Hospital, Calle O´Donnell 48, 28009, Madrid, Spain. 6. School of Medicine, Complutense University of Madrid, Madrid, Spain. 7. Gregorio Marañón Health Research Institute, Madrid, Spain. 8. Research Network On Maternal and Child Health and Development (Red SAMID), Madrid, Spain. 9. Department of Pediatric Radiology, Gregorio Marañón University Hospital, Madrid, Spain.
Abstract
BACKGROUND: This study aimed to assess observer variability and describe renal resistive index (RRI) and pulsatility index (PI) before and after onset of continuous kidney replacement therapy (CKRT). A secondary objective was to correlate Doppler ultrasound findings with those from direct measurement of renal blood flow (RBF). METHODS: This is a prospective observational study in hemodynamically stable Maryland piglets with and without acute kidney injury (AKI) and in hemodynamically unstable critically ill children requiring CKRT. Doppler-based RRI and PI were assessed for each subject. Measurements were made by two different operators (pediatric intensivists) before and after CKRT onset. RESULTS: Observer variability assessment in the measurement of RRI and PI rendered a moderate correlation for both RRI (ICC 0.65, IQR 0.51-0.76) and PI (ICC 0.63, IQR 0.47-0.75). RRI and PI showed no correlation with RBF or urine output. Baseline RRI and PI were normal in control piglets [RRI 0.68 (SD 0.02), PI 1.25 (SD 0.09)] and those with AKI [RRI 0.68 (SD 0.03), PI 1.20 (SD 0.13)]. Baseline RRI and PI were elevated in critically ill children (RRI 0.85, PI 2.0). PI and RRI did not change with CKRT in any study group. CONCLUSIONS: Observer variability between inexperienced pediatric intensivists was comparable with that between senior and junior operators. Doppler-based calculations did not correlate with invasive measurements of RBF. RRI and PI were normal in hemodynamically stable piglets with and without AKI. RRI and PI were high in hemodynamically unstable patients requiring CKRT. RRI and PI did not change after CKRT onset, despite changes in hemodynamic status. A higher resolution version of the Graphical abstract is available as Supplementary information.
BACKGROUND: This study aimed to assess observer variability and describe renal resistive index (RRI) and pulsatility index (PI) before and after onset of continuous kidney replacement therapy (CKRT). A secondary objective was to correlate Doppler ultrasound findings with those from direct measurement of renal blood flow (RBF). METHODS: This is a prospective observational study in hemodynamically stable Maryland piglets with and without acute kidney injury (AKI) and in hemodynamically unstable critically ill children requiring CKRT. Doppler-based RRI and PI were assessed for each subject. Measurements were made by two different operators (pediatric intensivists) before and after CKRT onset. RESULTS: Observer variability assessment in the measurement of RRI and PI rendered a moderate correlation for both RRI (ICC 0.65, IQR 0.51-0.76) and PI (ICC 0.63, IQR 0.47-0.75). RRI and PI showed no correlation with RBF or urine output. Baseline RRI and PI were normal in control piglets [RRI 0.68 (SD 0.02), PI 1.25 (SD 0.09)] and those with AKI [RRI 0.68 (SD 0.03), PI 1.20 (SD 0.13)]. Baseline RRI and PI were elevated in critically ill children (RRI 0.85, PI 2.0). PI and RRI did not change with CKRT in any study group. CONCLUSIONS: Observer variability between inexperienced pediatric intensivists was comparable with that between senior and junior operators. Doppler-based calculations did not correlate with invasive measurements of RBF. RRI and PI were normal in hemodynamically stable piglets with and without AKI. RRI and PI were high in hemodynamically unstable patients requiring CKRT. RRI and PI did not change after CKRT onset, despite changes in hemodynamic status. A higher resolution version of the Graphical abstract is available as Supplementary information.
Authors: Sarah N Fernández Lafever; Jorge López; Rafael González; María J Solana; Javier Urbano; Jesús López-Herce; Laura Butragueño; María J Santiago Journal: Pediatr Nephrol Date: 2021-01-12 Impact factor: 3.714