title: Influence of volume administration on Doppler-based renal resistive index, renal hemodynamics and renal function in medical intensive care unit patients with septic-induced acute kidney injury: a pilot study.
abstract: OBJECTIVE
  Impact of volume challenge (VC) on renal hemodynamics and renal function in patients with septic-induced acute kidney injury in addition to transpulmonary thermodilution (TPTD)-derived hemodynamic parameters.
  
  
  METHODS
  Systemic hemodynamic parameters derived from TPTD, Doppler-based resistive index (RI) urine output, creatinine and urea levels were obtained before, after and 24 h after VC.
  
  
  RESULTS
  Heart rate (p < 0.045), systolic blood pressure (p < 0.030) and mean arterial pressure (p < 0.001) were significantly altered after VC in VC responders compared to baseline immediately after VC but not after 24 h (p = 0.719; p = 0.576; p = 0.435).TPTD-derived cardiac function parameter cardiac index significantly increased after VC (p < 0.001) as well after 24 h (p < 0.02) in the responder group. Stroke volume index also significantly increased after VC (0.033) in responders immediately after VC, but not after 24 h of VC (p < 0.073). No significant changes could be observed in the non-responder group.Renal RI was not significantly different between VC responders and VC non-responders (p = 0.55) immediately after VC and after 24 h (p = 0.65).Creatinine levels in VC responders significantly decreased after 24 h (p < 0.001). Urine output increased from 400 to 542 ml/d in responders, but not statistically significant (p = 0.09). Vasopressor dose in VC responders was statistically significantly lower after 24 h (p < 0.001) compared to baseline.
  
  
  CONCLUSIONS
  Responders to VC with septic-induced AKI can benefit from an optimized hemodynamic environment. The resistive index to guide fluid therapy for renal hemodynamic management may be limited by the small magnitude of the changes.
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der, Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany. TobiasLahmer@me.com.
authors.forename: Tobias
authors.initials: T
authors.lastname: Lahmer
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der, Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Rasch
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der, Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Schnappauf
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der, Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Roland M
authors.initials: RM
authors.lastname: Schmid
authors.affiliation: II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der, Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huber
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012079:Renal Circulation / Q000502:physiology; D018570:Risk Assessment; D012772:Shock, Septic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D013815:Thermodilution; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014655:Vascular Resistance
keywords: Acute kidney injury; Critically ill; Renal resistive index; Septic shock; Transpulmonary thermodilution