Venous Excess Doppler ultrasound assessment and loop diuretic efficiency in acute cardiorenal syndrome.

IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY
Eslam Abu-Naeima, Moataz Fatthy, Mahmoud Amin Abu-Sheaishaa Shalaby, Ghada Ayeldeen, Frederik H Verbrugge, Philippe Rola, William Beaubien-Souligny, Ahmed Fayed
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Abstract

Background: Cardiorenal syndrome poses significant diagnostic and therapeutic challenges. The Venous Excess Ultrasound (VExUS) grading system based on the combination of venous Doppler assessments has shown potential in predicting acute kidney injury and cardiovascular outcomes, but its relevance regarding the management of acutely decompensated heart failure (ADHF) remains to be fully understood.

Methods: In this prospective study, patients with ADHF and acute kidney injury (AKI) were enrolled from a medical intensive care unit over 20 months. The study involved echocardiography and VExUS grading at admission and 72 h later. Data collection included clinical parameters, diuretic dosages, urine output, and fluid balance. Statistical analyses focused on exploring the relationships between VExUS grades and its components, including the renal venous stasis index (RVSI), diuretic efficiency, and renal function improvement.

Results: The cohort of 43 patients showed varied VExUS grades at admission. Higher VExUS grades were significantly associated with lower diuretic efficiency. Specifically, the mean urine output per 40 mg of furosemide was 368 ± 213 mL, with patients having VExUS grade 2 or 3 exhibiting reduced diuretic efficiency compared to those with grade 0-1 (Grade 2 vs. Grade 0-1: 333 ± 214 mL vs. 507 ± 189 mL, p = 0.02; Grade 3 vs. Grade 0-1: 270 ± 167 mL vs. 507 ± 189 mL, p = 0.004). The relationship between VExUS grade and diuretic efficiency was independent of admission creatinine and prior use of loop-diuretics (β = -106 CI: -180; -32 p = 0.006). Among the components of venous congestion assessment, the RVSI had the best ability to predict low diuretic efficiency (AUROC: 0.76 (0.60; 091) p = 0.001). Improvement in VExUS grade at 72 h was correlated with significant renal function improvement (84.6% vs. 47.1% for improved vs. non-improved VExUS grades, p = 0.03).

Conclusion: High VExUS and RVSI grades at admission are independently associated with reduced diuretic efficiency in ADHF patients with AKI. The findings emphasize the clinical value of venous congestion assessment in cardiorenal syndrome management including the selection of an initial diuretic dose.

急性心肾综合征的静脉过量多普勒超声评估和环利尿效果。
背景:心肾综合征提出了重大的诊断和治疗挑战。基于静脉多普勒评估的静脉过量超声(VExUS)分级系统已显示出预测急性肾损伤和心血管结局的潜力,但其与急性失代偿性心力衰竭(ADHF)管理的相关性仍有待充分了解。方法:在这项前瞻性研究中,ADHF和急性肾损伤(AKI)患者从医学重症监护病房入组超过20个月。研究包括入院时和72小时后的超声心动图和VExUS评分。数据收集包括临床参数、利尿剂剂量、尿量和体液平衡。统计分析的重点是探讨VExUS分级与其成分的关系,包括肾静脉停滞指数(RVSI)、利尿效率和肾功能改善。结果:43例患者在入院时表现出不同的VExUS分级。较高的VExUS分级与较低的利尿效率显著相关。具体来说,每40mg呋塞米的平均尿量为368±213 mL,与0-1级患者相比,VExUS 2级或3级患者的利尿效率降低(2级vs 0-1级:333±214 mL vs 507±189 mL, p = 0.02;3级vs. 0-1级:270±167 mL vs. 507±189 mL, p = 0.004)。VExUS分级与利尿效率的关系与入院肌酐和既往使用环利尿剂无关(β = -106 CI: -180;-32 p = 0.006)。在静脉充血评估的组成部分中,RVSI预测低利尿效率的能力最好(AUROC: 0.76 (0.60;091) p = 0.001)。72 h时VExUS分级的改善与肾功能的显著改善相关(改善和未改善的VExUS分级分别为84.6%和47.1%,p = 0.03)。结论:入院时高VExUS和RVSI分级与ADHF合并AKI患者利尿效率降低独立相关。研究结果强调静脉充血评估在心肾综合征管理中的临床价值,包括初始利尿剂剂量的选择。
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来源期刊
BMC Nephrology
BMC Nephrology UROLOGY & NEPHROLOGY-
CiteScore
4.30
自引率
0.00%
发文量
375
审稿时长
3-8 weeks
期刊介绍: BMC Nephrology is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of kidney and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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