The value of inferior vena cava ultrasonography administration for hypovolemia detection in patients with acute kidney injury hospitalized in intensive care unit

Abbasi, Saeed; Nemati, Kourosh; Alikiaii, Babak; Saghaei, Mahmood

The value of inferior vena cava ultrasonography administration for hypovolemia detection in patients with acute kidney injury hospitalized in intensive care unit

Authors

¹ Department of Anesthesia and Critical Care, Anesthesiology and Critical Care Research Center, Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

² Department of Anesthesia and Critical Care, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The hypo-perfusion of the kidneys can lead to impairment in renal function and induce renal injury in case of delayed diagnosis and treatment. To date, laboratory markers are routinely used to determine the fluid volume status of the patients. The current study aims to evaluate the values of inferior vena cava (IVC) collapsibility index in hypovolemia diagnosis among critical patients admitted at the intensive care unit (ICU).
Materials and Methods: This is a cross-sectional study performed on 67 patients admitted to the ICU due to acute kidney injury from May 2018 to October 2019. Hypovolemia was assessed assessing IVC collapsibility using ultrasonography. Laboratory data, including urine osmolality, urine-plasma creatinine ratio, sodium excretion fraction and urinary sodium level were checked. Afterward, IVC collapsibility index was measured for each patient using ultrasonography and the values of this index in accordance with the mentioned criteria was evaluated. Accordingly, reciever operating curve was depicted.
Results: There was no significant asosociation between IVC collapsibility index with fractional excretion of sodium (P = 0.69), urine Na (P = 0.93) and urine osmolality ([P = 0.09]), while urine: Plasma creatinie ration revealed a significant association with IVC collapsibility index at cut point of 40.5% with sensitivity and specificity of 96% and 44% (P = 0.017, area under the curve: 0.67, 95% confidence interval: 0.551–0.804), respectively.
Conclusion: According to the findings of this study, IVC collapsibility detected via ultrasonography was not an appropriate index to figure out hypovolemia in ICU patients. Furthermore, detailed studies are recommended.

Keywords

References

1.	Challiner R, Ritchie JP, Fullwood C, Loughnan P, Hutchison AJ. Incidence and consequence of acute kidney injury in unselected emergency admissions to a large acute UK hospital trust. BMC Nephrol 2014;15:84.
2.	Davison SN. Clinical pharmacology considerations in pain management in patients with advanced kidney failure. Clin J Am Soc Nephrol 2019;14:917-31.
3.	Shah S, Leonard AC, Harrison K, Meganathan K, Christianson AL, Thakar CV. Mortality and recovery associated with kidney failure due to acute kidney injury. Clin J Am Soc Nephrol 2020;15:995-1006.
4.	Huluka D, Ejigu A, Tilahun R, Yohannes N, Ahmed M, Tadesse Y, et al. Clinical Characteristics and Outcomes of Acute Kidney Injury in Adult Intensive Care Unit of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. B47 CRITICAL CARE: NON-PULMONARY CRITICAL CARE: American Thoracic Society; 2020. p. A 3559.
5.	Lafrance JP, Miller DR. Acute kidney injury associates with increased long-term mortality. J Am Soc Nephrol 2010;21:345-52.
6.	Umbrello M, Formenti P, Chiumello D. Urine electrolytes in the Intensive Care Unit: From pathophysiology to clinical practice. Anesth Analg 2020;131:1456-70.
7.	Villeneuve PM, Bagshaw SM. Assessment of urine biochemistry. In: Critical Care Nephrology. Ch. 55. Elsivier; 2019. p. 323-328.el.
8.	Stawicki SP, Braslow BM, Panebianco NL, Kirkpatrick JN, Gracias VH, Hayden GE, et al. Intensivist use of hand-carried ultrasonography to measure IVC collapsibility in estimating intravascular volume status: Correlations with CVP. J Am Coll Surg 2009;209:55-61.
9.	Kaptein MJ, Kaptein EM. Inferior vena cava collapsibility index: Clinical validation and application for assessment of relative intravascular volume. Adv Chronic Kidney Dis 2021;28:218-26.
10.	Muhsin SA, Mount DB. Diagnosis and treatment of hypernatremia. Best Pract Res Clin Endocrinol Metab 2016;30:189-203.
11.	Sadiq NM, Naganathan S, Badireddy M. Hypercalcemia. In: StatPearls Publishing LCC; 2020.
12.	Moore PK, Hsu RK, Liu KD. Management of acute kidney injury: Core curriculum 2018. Am J Kidney Dis 2018;72:136-48.
13.	Kellum JA, Lameire N, KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: A KDIGO summary (Part 1). Crit Care 2013;17:204.
14.	DeMers D, Wachs D. Physiology, mean arterial pressure. In: StatPearls Publishing LCC; 2020.
15.	Waldrop JE. Urinary electrolytes, solutes, and osmolality. Vet Clin North Am Small Anim Pract 2008;38:503-12, ix.
16.	Iturbide I, Santiago M, Henain F, Golab K, Tentoni M, Fuentes S. Ultrasound evaluation of the inferior vena cava in hemodynamically unstable patients. Rev Argent Radiol 2017;81:209-13.
17.	Hicks P, Cooper D, Webb S, Myburgh J, Seppelt I, Peake S, et al. The Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2008. An Assessment by the Australian and New Zealand Intensive Care Society. SAGE Publications Sage UK: London, England; 2008.
18.	Alsous F, Khamiees M, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Negative fluid balance predicts survival in patients with septic shock: A retrospective pilot study. Chest 2000;117:1749-54.
19.	Wiedemann H, Wheeler A, Bernard G. Comparison of two fluid-management strategies in acute lung injury. J Vasc Surg 2006;44:909.
20.	Babar F, Singh G, Noor M, Sabath B. Retrospective analysis of inferior vena cava collapsibility with point of care ultrasound and urine sodium and FENa in patients with early stage acute kidney injury. J Community Hosp Intern Med Perspect 2017;7:296-9.
21.	Airapetian N, Maizel J, Alyamani O, Mahjoub Y, Lorne E, Levrard M, et al. Does inferior vena cava respiratory variability predict fluid responsiveness in spontaneously breathing patients? Crit Care 2015;19:400.
22.	Szabó M, Bozó A, Darvas K, Horváth A, Iványi ZD. Role of inferior vena cava collapsibility index in the prediction of hypotension associated with general anesthesia: An observational study. BMC Anesthesiol 2019;19:139.
23.	Sobczyk D, Nycz K, Andruszkiewicz P, Wierzbicki K, Stapor M. Ultrasonographic caval indices do not significantly contribute to predicting fluid responsiveness immediately after coronary artery bypass grafting when compared to passive leg raising. Cardiovasc Ultrasound 2016;14:23.
24.	Moretti R, Pizzi B. Inferior vena cava distensibility as a predictor of fluid responsiveness in patients with subarachnoid hemorrhage. Neurocrit Care 2010;13:3-9.

Advanced Biomedical Research