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CC BY-NC-ND 4.0 · Ultrasound Int Open 2018; 4(04): E142-E148
DOI: 10.1055/a-0684-9483
Original Article

Sonographic Venous Velocity Index Identifies Patients with Chronic Kidney Disease and Severe Diastolic Dysfunction

Markus Meier
1   Nephrology Center Reinbek and Geesthacht, Outpatient Clinic, Reinbek, Germany
,
Wolfram Johannes Jabs
2   Vivantes Klinikum im Friedrichshain, Nephrology, Berlin, Germany
,
Maria Guthmann
3   Krankenhaus-Reinbek Sankt Adolf-Stift, Cardiology, Reinbek, Germany
,
Gesa Geppert
1   Nephrology Center Reinbek and Geesthacht, Outpatient Clinic, Reinbek, Germany
,
Ali Aydin
3   Krankenhaus-Reinbek Sankt Adolf-Stift, Cardiology, Reinbek, Germany
,
Martin Nitschke
4   Universitat zu Lubeck Sektion Medizin, Medical Clinic I, Lubeck, Germany
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Correction: Sonographic Venous Velocity Index Identifies Patients with Chronic Kidney Disease and Severe Diastolic DysfunctionUltrasound Int Open 2018; 4(04): E149-E149
DOI: 10.1055/a-1792-6524

Abstract

Objective

Diagnosing cardiorenal syndrome (CRS) in patients with chronic kidney disease (CKD) continues to remain challenging in outpatient practice. In this study, we investigate whether a newly developed venous velocity ultrasound index (VVI) can differentiate between patients with CRS and patients with CKD of other cause or normal renal function (NRF).

Methods

Patients with CRS (n=30), CKD (n=30), and NRF (n=30) were included in the study. For each patient, duplex ultrasound scans of intrarenal segmental veins were retrospectively analyzed. The VVI was calculated from the renal venous doppler curve as the ratio of the maximal positive venous velocity to the maximal negative venous velocity. Patients with CRS were compared to age-matched controls with NRF and to GFR-matched controls with CKD.

Results:

The GFRs of patients with CRS and those with CKD were comparable (26.4±5 and 25.6±7 ml/min/m2), as was the age in patients with CRS and NRF (6 ±12 years and 68±16 years, respectively). There was no significant difference in ejection fraction between patients with CRS and those with CKD (44.2±6.2% vs. 47.4 ±7.2), but there was a significant decrease compared to those with NRF (52.6 ±5.1, p<0.01). The VVI was significantly higher in the CRS group (0.81± 0.18) compared to the CKD group (0.18± 0.17, p<0.01) or NRF group (0.22± 0.20, p<0.01). The positive predictability of CRS was 96.4% in patients with VVI values of >0.6.

Conclusion

The newly developed VVI was useful in successfully predicting severe diastolic dysfunction (CRS) in patients with severe kidney injury in outpatient care.

Key words

cardiorenal syndrome - renal ultrasound - renal venous congestion - chronic kidney disease


Publication History

Received: 03 February 2018
Received: 04 June 2018

Accepted: 22 July 2018

Article published online:
25 October 2018

© 2018. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol 2008; 52 (19) 1527-1539
    CrossrefPubMedGoogle Scholar
  • 2 Andrukonis K, Bell C, Bodine L, McDowell EH, Reich S, Gregory T. Cardiorenal syndrome: Understanding the connections between cardiac and renal disease. JAAPA 2014; 27 (02) 12-7. doi:10.1097/01.JAA.0000442697.65104.e2
    CrossrefPubMedGoogle Scholar
  • 3 Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, Jafar TH, Heerspink HJ, Mann JF. et al. Chronic kidney disease and cardiovascular risk: Epidemiology, mechanisms, and prevention. Lancet 2013; 382 9889 339-52 DOI: 10.1016/S0140-6736(13)60595-4.Epub 2013 May 31.
    CrossrefPubMedGoogle Scholar
  • 4 Granata A, Clementi A, Virzì GM, Brocca A, de Cal M, Scarfia VR. et al. Cardiorenal syndrome type 4: From chronic kidney disease to cardiovascular impairment. Eur J Intern Med 2016; 30: 1-6 DOI: 10.1016/j.ejim.2016.02.019.Epub 2016 Mar 6.
    CrossrefPubMedGoogle Scholar
  • 5 Tsuruya K.Eriguchi M Yamada S Hirakata H Kitazono T. Cardiorenal syndrome in end-stage kidney disease. Blood Purif 2015; 40 (4): 337–43. doi:10.1159/000441583. Epub 2015 Nov 17
    PubMed
  • 6 Sperry BW, Campbell J, Yanavitski M, Kapadia S, Tang WHW, Hanna M. Peripheral venous pressure measurements in patients with acute decompensated heart failure (PVP-HF). Circ Heart Fail 2017; 10 (07) pii e004130 DOI: 10.1161/CIRCHEARTFAILURE.117.004130.
    CrossrefPubMedGoogle Scholar
  • 7 Poelzl G, Ess M, Von der Heidt A, Rudnicki M, Frick M, Ulmer H. Concomitant renal and hepatic dysfunctions in chronic heart failure: Clinical implications and prognostic significance. Eur J Intern Med 2013; 24 (02) 177-182
    CrossrefPubMedGoogle Scholar
  • 8 Ronco C, Di Lullo L. Cardiorenal syndrome in western countries: Epidemiology, diagnosis and management approaches. Kidney Dis 2017; 2 (04) 151-163
    CrossrefPubMedGoogle Scholar
  • 9 Meier M, Winterhoff J, Fricke L, Lehnert H, Nitschke M.. Compensatory capacity of the remnant kidney after living kidney donation: long term follow up. Transplant Proc 2017; 49 (09) 1993-1998
    CrossrefPubMedGoogle Scholar
  • 10 Meier M, Fricke L, Eikenbusch K, Smith E, Kramer J, Lehnert H. et al. The serial duplex index improves differential diagnosis of acute renal transplant dysfunction. J Ultrasound Med 2017; 26: 1607-1615
    CrossrefPubMedGoogle Scholar
  • 11 Hagendorff A.. Transthoracic echocardiography in adult patients – A proposal for documenting a standardized investigation. Ultraschall Med 2008; 29: 344
    PubMedGoogle Scholar
  • 12 Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015; 16: 233
    PubMed
  • 13 Ismail Y, Kasmikha Z, Green HL, McCullough PA. Cardio-renal syndrome type 1: Epidemiology, pathophysiology, and treatment. Semin Nephrol. 2012; 32 (01) 18-25
    CrossrefPubMedGoogle Scholar
  • 14 Grande D, Terlizzese P, Iacoviello M. Role of imaging in the evaluation of renal dysfunction in heart failure patients. World J Nephrol 2017; 6 (03) 123-131. Published online 2017 May 6. DOI: 10.5527/wjn.v6.i3.123.
    CrossrefPubMedGoogle Scholar
  • 15 Viazzi F, Leoncini G, Derchi LE, Pontremoli R. Ultrasound Doppler renal resistive index: A useful tool for the management of the hypertensive patient. Journal of Hypertension 2014; 32 (01) 149-153. doi:10.1097/HJH.0b013e328365b29c
    CrossrefPubMedGoogle Scholar
  • 16 Tublin ME, Bude RO, Platt JF. Review. The resistive index in renal Doppler sonography: Where do we stand?. AJR Am J Roentgenol 2003; 180: 885-892
    CrossrefPubMedGoogle Scholar
  • 17 Parolini C, Noce A, Staffolani E, Giarrizzo GF, Costanzi S, Splendiani G. Renal resistive index and long-term outcome in chronic nephropathies. Radiology 2009; 252: 888-896
    CrossrefPubMedGoogle Scholar
  • 18 Iida N, Seo Y, Sai S, Machino-Ohtsuka T, Yamamoto M, Ishizu T. et al. Clinical implications of intrarenal hemodynamic evaluation by doppler ultrasonography in heart failure JACC Heart Fail. 2016; 4 (08) 674-82 DOI: 10.1016/j.jchf.2016.03.016.. Epub 2016 May 11
    CrossrefPubMedGoogle Scholar
  • 19 Nijst P, Martens P, Dupont M, Tang WHW, Mullens W. Intrarenal flow alterations during transition from euvolemia to intravascular volume expansion in heart failure patients. JACC Heart Fail 2017; 5 (09) 672-681
    CrossrefPubMedGoogle Scholar
  • 20 Bock JS, Gottlieb SS. Cardiorenal Syndrom. New perspectives. Circulation 2010; 121: 2592-2600
    CrossrefPubMedGoogle Scholar
  • 21 Forman DE, Butler J, Wang Y, Abraham WT, O’Connor CM, Gottlieb SS. et al. Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure. J Am Coll Cardiol 2004; 43: 61-67
    CrossrefPubMedGoogle Scholar