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De Souza FM, De Carvalho AV, Ferraz IS, Damiano AP, Brandão MB, Nogueira RJN, De Souza TH. Acute kidney injury in children undergoing cardiac surgery: predictive value of kidney arterial Doppler-based variables. Pediatr Nephrol 2024:10.1007/s00467-024-06319-3. [PMID: 38416215 DOI: 10.1007/s00467-024-06319-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/03/2024] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common condition in critically ill children and is associated with increased morbidity and mortality. This study aimed to assess the performance of point-of-care ultrasonography to predict AKI in children undergoing cardiac surgery. METHODS In this prospective study, consecutive children underwent kidney Doppler ultrasound examination within 24 h following cardiac surgery, and an experienced operator obtained both renal resistive index (RRI) and renal pulsatility index (RPI). AKI was defined by the Kidney Disease Improving Global Outcome (KDIGO) criteria. The primary outcome was the diagnosis of severe AKI (KDIGO stage 2 or 3) on day 3. RESULTS A total of 58 patients were included. Median age and weight were 12.9 months (IQR 6.0-37.9) and 7.36 kg (IQR 5.19-11.40), respectively. On day 3, 13 patients were classified as having AKI, of which 11 were severe. RRI could effectively predict AKI (area under the ROC curve [AUC] 0.83, 95% CI 0.71-0.92; p < 0.001) as well as RPI (AUC 0.81, 95% CI 0.69-0.90; p < 0.001). The optimal cutoff value for RRI was 0.85 (sensitivity, 73%; specificity, 83%; positive predictive value [PPV], 50%; and negative predictive value [NPV], 93%), while for RPI was 1.95 (sensitivity, 73%; specificity, 78%; PPV, 44%; and NPV, 92%). Similar results were found in the analysis for prediction on day 5. Significant correlations were found between Doppler-based variables and estimated GFR and furosemide dose on day 3. CONCLUSIONS Kidney Doppler ultrasound may be a promising tool for predicting AKI in children undergoing cardiac surgery.
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Affiliation(s)
- Fabiane M De Souza
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
| | - Aline V De Carvalho
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
| | - Isabel S Ferraz
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
| | - Ana P Damiano
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
| | - Marcelo B Brandão
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
| | - Roberto J N Nogueira
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
- Department of Pediatrics, School of Medicine, São Leopoldo Mandic, Campinas, SP, Brazil
| | - Tiago H De Souza
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil.
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