Validation of bedside measurements of absolute human renal blood flow by a continuous thermodilution technique

Abstract

Background and methods: There is a clinical need for a system that would allow rapid assessment of renal blood flow in patients with oliguric circulatory shock. A local, continuous thermodilution technique for the measurement of renal venous blood flow, using readily available equipment, was developed. To test the hypothesis that this system would allow measurement of renal blood flow in clinical situations, we compared simultaneous measurements made by the continuous thermodilution technique with measurements of: a) absolute flow measured by volumetric collection in an in vitro flow model; b) renal arterial blood flow measured by electromagnetic flow probe under changing hemodynamic conditions in nine pigs; and c) calculated renal blood flow derived from a clearance technique in 16 patients after cardiac catheterization. The technique utilizes a short-duration, constant infusion of room temperature normal saline into the renal vein via a retrograde thermodilution catheter, with measurement of flow at a thermistor 1 cm back from the tip of the catheter.

Results: The method measured absolute blood flow in an in vitro model, with a correlation coefficient of .99 over blood flows ranging from 55 to 885 mL/min (r2 = .98). There was a .92 correlation coefficient with renal arterial blood flow measured by electromagnetic flow probe in a pig model (r2 = .85), and a .8 correlation with simultaneous measurement of renal blood flow by corrected iodohippurate clearance in humans (r2 = .64). Compared with electromagnetic flow probe measurements, a single measurement by the thermodilution technique would be accurate to within 80 mL/min in 95% of cases. Variability between individual measurements, expressed as the mean of the coefficient of variance for each patient, was 5.5 +/- 3.7%.

Conclusions: This technique is simple to use, requires only venous cannulation and injection of normal saline, and allows rapidly repeatable, immediately available measurements of renal blood flow in a wide range of clinical circumstances, including severe renal impairment or anuria.