Prospective Study of Ultrasound Markers of Organ Congestion in Critically Ill Patients With Acute Kidney Injury

doi:10.1016/j.ekir.2023.12.018

. 2023 Dec 29;9(3):694-702.

doi: 10.1016/j.ekir.2023.12.018. eCollection 2024 Mar.

Prospective Study of Ultrasound Markers of Organ Congestion in Critically Ill Patients With Acute Kidney Injury

William Beaubien-Souligny^{1

2}, Laura Galarza³, Brian Buchannan⁴, Vincent I Lau⁴, Neill K J Adhikari⁵, Jean Deschamps⁶, Emmanuel Charbonney⁷, André Denault⁸, Ron Wald⁹

Affiliations

¹ Innovation hub, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
² Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
³ Department of Intensive Care, Hospital General Universitari de Castelló, Castelló de la Plana, Spain.
⁴ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada.
⁵ Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA.
⁷ Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
⁸ Division of Anesthesiology, Montreal Heart Institute, Montréal, Quebec, Canada.
⁹ Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada.

PMID: 38481488
PMCID: PMC10927464
DOI: 10.1016/j.ekir.2023.12.018

Prospective Study of Ultrasound Markers of Organ Congestion in Critically Ill Patients With Acute Kidney Injury

William Beaubien-Souligny et al. Kidney Int Rep. 2023.

. 2023 Dec 29;9(3):694-702.

doi: 10.1016/j.ekir.2023.12.018. eCollection 2024 Mar.

Authors

William Beaubien-Souligny^{1

2}, Laura Galarza³, Brian Buchannan⁴, Vincent I Lau⁴, Neill K J Adhikari⁵, Jean Deschamps⁶, Emmanuel Charbonney⁷, André Denault⁸, Ron Wald⁹

Affiliations

¹ Innovation hub, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
² Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
³ Department of Intensive Care, Hospital General Universitari de Castelló, Castelló de la Plana, Spain.
⁴ Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada.
⁵ Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA.
⁷ Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.
⁸ Division of Anesthesiology, Montreal Heart Institute, Montréal, Quebec, Canada.
⁹ Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada.

PMID: 38481488
PMCID: PMC10927464
DOI: 10.1016/j.ekir.2023.12.018

Abstract

Introduction: Organ congestion may be a mediator of adverse outcomes in critically ill patients with severe acute kidney injury (AKI). The presence of abnormal venous Doppler waveforms could identify patients with clinically significant organ congestion who may benefit from a decongestive strategy.

Methods: This prospective multicenter cohort study enrolled patients with severe AKI defined as Kidney Disease: Improving Global Outcomes stage 2 or higher. Patients were not eligible if they received renal replacement therapy (RRT) for more than 72 hours at the time of screening. Participants underwent serial Doppler ultrasound examinations of the portal, hepatic and intrarenal veins during the week following enrolment. We calculated the venous excess ultrasound (VExUS) score based on these data. The primary outcome studied was major adverse kidney events at 30 days (MAKE30) defined as death, RRT dependence, or a persistent decrease in kidney function.

Results: A total of 125 patients were included for whom 291 ultrasound assessments were performed. Severely abnormal venous waveforms were documented in 14.4% of portal vein assessments, 6.5% of intrarenal venous assessments, and 14.4% of hepatic vein assessments. The individual ultrasound markers were not associated with MAKE30. The VExUS score (grade 0-1: reference; grade 2: adjusted hazard ratio [aHR]: 4.03, confidence interval [CI]: 1.81-8.99; grade 3: aHR: 2.70, CI: 1.10-6.65; P = 0.03), as well as severely abnormal portal, hepatic and intrarenal vein Doppler were each independently associated with mortality.

Conclusion: Although not significantly associated with MAKE30, venous Doppler abnormalities suggestive of venous congestion were associated with higher mortality in critically ill patients with severe AKI.

Keywords: VExUS; acute kidney injury; cardiorenal; fluid balance; organ congestion; venous Doppler.

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Figures

**Figure 1**
Participant outcomes in the first 30 days after enrolment. (a) Major adverse kidney events according to ultrasound markers at enrolment. (b) Kaplan-Meier curves illustrating survival according to Venous Excess UltraSound (VExUS) grading at enrolment in the first 30 days after enrolment (Log-rank P = 0.049).

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References

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1. Bouchard J., Soroko S.B., Chertow G.M., et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int. 2009;76:422–427. doi: 10.1038/ki.2009.159. - DOI - PubMed
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1. Bellomo R., Cass A., Cole L., et al. An observational study fluid balance and patient outcomes in the Randomized Evaluation of Normal vs. augmented Level of Replacement Therapy trial. Crit Care Med. 2012;40:1753–1760. doi: 10.1097/CCM.0b013e318246b9c6. - DOI - PubMed
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[1] Prowle J.R., Kirwan C.J., Bellomo R. Fluid management for the prevention and attenuation of acute kidney injury. Nat Rev Nephrol. 2014;10:37–47. doi: 10.1038/nrneph.2013.232. - DOI - PubMed

[2] Prowle J.R., Kirwan C.J., Bellomo R. Fluid management for the prevention and attenuation of acute kidney injury. Nat Rev Nephrol. 2014;10:37–47. doi: 10.1038/nrneph.2013.232. - DOI - PubMed

[3] Bouchard J., Soroko S.B., Chertow G.M., et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int. 2009;76:422–427. doi: 10.1038/ki.2009.159. - DOI - PubMed

[4] Bouchard J., Soroko S.B., Chertow G.M., et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int. 2009;76:422–427. doi: 10.1038/ki.2009.159. - DOI - PubMed

[5] Heung M., Wolfgram D.F., Kommareddi M., Hu Y., Song P.X., Ojo A.O. Fluid overload at initiation of renal replacement therapy is associated with lack of renal recovery in patients with acute kidney injury. Nephrol Dial Transplant. 2012;27:956–961. doi: 10.1093/ndt/gfr470. - DOI - PMC - PubMed

[6] Heung M., Wolfgram D.F., Kommareddi M., Hu Y., Song P.X., Ojo A.O. Fluid overload at initiation of renal replacement therapy is associated with lack of renal recovery in patients with acute kidney injury. Nephrol Dial Transplant. 2012;27:956–961. doi: 10.1093/ndt/gfr470. - DOI - PMC - PubMed

[7] Bellomo R., Cass A., Cole L., et al. An observational study fluid balance and patient outcomes in the Randomized Evaluation of Normal vs. augmented Level of Replacement Therapy trial. Crit Care Med. 2012;40:1753–1760. doi: 10.1097/CCM.0b013e318246b9c6. - DOI - PubMed

[8] Bellomo R., Cass A., Cole L., et al. An observational study fluid balance and patient outcomes in the Randomized Evaluation of Normal vs. augmented Level of Replacement Therapy trial. Crit Care Med. 2012;40:1753–1760. doi: 10.1097/CCM.0b013e318246b9c6. - DOI - PubMed

[9] Perren A., Markmann M., Merlani G., Marone C., Merlani P. Fluid balance in critically ill patients. Should we really rely on it? Minerva Anestesiol. 2011;77:802–811. - PubMed

[10] Perren A., Markmann M., Merlani G., Marone C., Merlani P. Fluid balance in critically ill patients. Should we really rely on it? Minerva Anestesiol. 2011;77:802–811. - PubMed

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Prospective Study of Ultrasound Markers of Organ Congestion in Critically Ill Patients With Acute Kidney Injury

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Prospective Study of Ultrasound Markers of Organ Congestion in Critically Ill Patients With Acute Kidney Injury

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