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Feasibility of renal resistive index measurements performed by an intermediate and novice sonographer in a volunteer population.

ABSTRACT: BACKGROUND:The Doppler-derived renal resistive index (RRI) is emerging as a promising bedside tool for assessing renal perfusion and risk of developing acute kidney injury in critically ill patients. It is not known what level of ultrasonography competence is needed to obtain reliable RRI values. OBJECTIVE:The aim of this study was to evaluate the feasibility of RRI measurements by an intermediate and novice sonographer in a volunteer population. METHODS:After a focused teaching session, an intermediate (resident), novice (medical student) and expert sonographer performed RRI measurements in 23 volunteers consecutively and blinded to the results of one another. Intraclass correlation coefficients and Bland-Altman plots were used to evaluate interobserver reliability, bias and precision. RESULTS:Both non-experts were able to obtain RRI values in all volunteers. Median RRI in the population measured by the expert was 0.58 (interquartile range 0.52-0.62). The intraclass correlation coefficient was 0.96 (95% confidence interval 0.90-0.98) for the intermediate and expert, and 0.85 (95% confidence interval 0.69-0.94) for the novice and expert. In relation to the measurements of the expert, both non-experts showed negligible bias (mean difference 0.002 [95% confidence interval -?0.005 to 0.009, p?=?0.597] between intermediate and expert, mean difference 0.002 [95% confidence interval -?0.011 to 0.015, p?=?0.752] between novice and expert) and clinically acceptable precision (95% limits of agreement -?0.031 to 0.035 for the intermediate, 95% limits of agreement -?0.056 to 0.060 for the novice). CONCLUSIONS:RRI measurements by both an intermediate and novice sonographer in a volunteer population were reliable, accurate and precise after a brief course. RRI is easy to learn and feasible within the scope of point-of-care ultrasound.

SUBMITTER: Renberg M

PROVIDER: S-EPMC7237552 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Feasibility of renal resistive index measurements performed by an intermediate and novice sonographer in a volunteer population.

Renberg Mårten M Kilhamn Naima N Lund Kent K Hertzberg Daniel D Rimes-Stigare Claire C Bell Max M

The ultrasound journal 20200520 1

<h4>Background</h4>The Doppler-derived renal resistive index (RRI) is emerging as a promising bedside tool for assessing renal perfusion and risk of developing acute kidney injury in critically ill patients. It is not known what level of ultrasonography competence is needed to obtain reliable RRI values.<h4>Objective</h4>The aim of this study was to evaluate the feasibility of RRI measurements by an intermediate and novice sonographer in a volunteer population.<h4>Methods</h4>After a focused tea ...[more]

PMID: 32430724

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Project description:BackgroundHigh ultrasound renal resistive index (RI) predicts poor cardiorenal outcomes in chronic kidney disease (CKD) and has recently emerged as a marker of nephroprotective drugs response. Thus, having a risk profile of CKD patients with abnormal RI may be relevant for the clinicians.MethodsConsecutive patients referred to our non-dialysis CKD clinic from 01/01/2016 to 01/12/2016, were evaluated by clinical and ultrasound analysis. Inclusion criteria were age >18 years and presence of CKD defined as estimated glomerular filtration rate (eGFR)<60 mL/min/1.73m2 and/or proteinuria>0.150g/24h. Renal artery stenosis, solitary kidney, acute kidney injury were the main exclusion criteria. RI value was the mean of three measures in segmental arteries in each kidney. Univariate analysis was performed to evaluate associations between continuous RI and clinical variables. Multivariate linear regression analysis, based on stepwise method with an elimination criterion of p<0.10, was used to assess the independent correlates of RI as continuous variable.ResultsWe studied 73 patients (69.9% men). Mean RI was 0.67±0.09. Frequencies of diabetes and cardiovascular disease (CVD) were 19.2% and 20.6% and median eGFR 54.1 [30.0-84.6] mL/min/1.73m2. From low (<0.65) to intermediate (0.65-0.70) to high (>0.70) RI categories, eGFR and haemoglobin levels were decreased while diabetes, cardiovascular disease (CVD), phosphate and smokers were higher. At univariate analysis, RI was significantly associated with age, presence of diabetes, CVD, serum phosphorus, eGFR, Urea and haemoglobin. Multi-adjusted stepwise regression analysis showed that lower eGFR levels (p<0.001), diabetes (p = 0.042), CVD (p = 0.009), smoking habit (p = 0.021) and higher serum phosphorus levels (p = 0.001) were associated with higher continuous RI. Serum phosphorus showed Area Under the Curves (AUC) values of 0.714 and 0.664 for discriminating RI cut-offs of 0.70 and 0.65.ConclusionsThis analysis suggests that RI is higher in CKD patients with CVD, diabetes, smoking habit and higher serum phosphorus, regardless of eGFR. Further studies are needed to verify whether higher RI indicates more complex pathway of intrarenal damage, besides and beyond kidney function.

Dataset Information

Feasibility of renal resistive index measurements performed by an intermediate and novice sonographer in a volunteer population.

Publications

Feasibility of renal resistive index measurements performed by an intermediate and novice sonographer in a volunteer population.

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