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Observational Study
. 2023 Aug 12;21(1):541.
doi: 10.1186/s12967-023-04407-w.

Influence of arterial blood gases on the renal arterial resistive index in intensive care unit

Stéphanie Ruiz  1 , Fanny Vardon-Bounes  2 , Marie Virtos  2 , Thierry Seguin  2 , Laure Crognier  2 , Antoine Rouget  2 , Bernard Georges  2 , Jean-Marie Conil  2 , Vincent Minville  2   3
Affiliations
Observational Study

Influence of arterial blood gases on the renal arterial resistive index in intensive care unit

Stéphanie Ruiz et al. J Transl Med. .

Abstract

Background: Renal artery Doppler sonography with resistive index (RI) determination is a noninvasive, fast, and reliable diagnostic tool increasingly used in the intensive care unit (ICU) to predict and assess the reversibility of acute kidney injury (AKI). However, interpreting the RI can be challenging due to numerous influencing factors. While some studies have explored various confounding factors, arterial blood gases have received limited attention. Therefore, our study aims to evaluate the impact of arterial blood gases on the RI in the ICU setting.

Methods: This prospective observational study enrolled ICU patients who required blood gas analysis and had not experienced significant hemodynamic changes recently. The RI was measured using standardized Doppler ultrasound within an hour of the arterial blood gases sampling and analysis.

Results: A total of sixty-four patients were included in the analysis. Univariate analysis revealed a correlation between the RI and several variables, including PaCO2 (R = 0.270, p = 0.03), age (R = 0.574, p < 0.0001), diastolic arterial pressure (DAP) (R = - 0.368, p = 0.0028), and SaO2 (R = - 0.284, p = 0.0231). Multivariate analysis confirmed that age > 58 years and PaCO2 were significant factors influencing the RI, with respective odds ratios of 18.67 (p = 0.0003) and 1.132 (p = 0.0267).

Conclusion: The interpretation of renal arterial RI should take into account thresholds for PaCO2, age, and diastolic arterial pressure. Further studies are needed to develop a comprehensive scoring system that incorporates all these cofactors for a reliable analysis of RI levels. Trial registration This observational study, registered under number 70-0914, received approval from local Ethical Committee of Toulouse University Hospital.

Keywords: Acute kidney injury; Arterial blood gases; Intensive care unit; Renal artery Doppler; Resistive index.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Relationship between resistivity index (RI), age measured creatinine clearance (CLCR), diastolic arterial pressure (DAP), PaCO2and SaO2. A RI and age: the relationship is significant for total population R = 0.574 (p < 0.0001*), for normal glomerular filtration rates (GFRs) (p = 0.0246*) and for decreased GFRs (p = 0.0201*) but not observed for augmented renal clearance (ARC) (p = 0.0639). B RI and measured CLCR: relationship is significant for total population R = − 0.424 (p = 0.0005*), for normal GFRs (p = 0.0399*) and for decreased GFRs (p = 0.0439*) but not observed for ARC (p = 0.4198). C RI and DAP: the relationship is significant for the total population R = − 0.368 (p = 0.0028*), normal GFRs (p = 0.0061*) but not observed for decreased GFRs (p = 0.3794) and for ARC (p = 0.9730). D RI and PCO2: the relationship is significant for the overall population R = 0.270 (p = 0.0310*) E RI and SaO2: the relationship is significant for the overall population R = − 0.284 (p = 0.0231*). *Statistically significant
Fig. 2
Fig. 2
Comparison of Resistivity Index (RI) of patients according to their glomerular filtration rate (GFR) level. A RI in patients with normal GFR, ARC and decreased GFR. B RI of patients with ARC vs. non ARC. C RI of patients with decreased DFG vs. normal GFR or ARC patients
Fig. 3
Fig. 3
Comparison of RI of polytrauma patients, patients hospitalized for surgical reason or medical reason
Fig. 4
Fig. 4
Partitioning of patients according to their Resistivity Index (RI) > or ≤ 0.7 according to their age (> or ≤ 58 years), their PaCO2 level and their Diastolic Arterial Pressure (DAP).
See this image and copyright information in PMC

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