Doppler-based renal resistive index for prediction of renal dysfunction reversibility: A systematic review and meta-analysis

• Published in: Journal of critical care Vol. 30; no. 3; pp. 629 - 635
• Main Authors: Ninet, Sebastien, Schnell, David, Dewitte, Antoine, Zeni, Fabrice, Meziani, Ferhat, Darmon, Michael
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2015; Elsevier Limited
• Subjects: Accuracy; Acquisitions & mergers; Acute kidney injury; Acute Kidney Injury - diagnosis; Acute Kidney Injury - diagnostic imaging; Critical Care; Critical Illness; Critically ill; Doppler ultrasonography; Heart surgery; Humans; Intensive care; Kidney - blood supply; Kidney - diagnostic imaging; Medical Subject Headings-MeSH; Meta-analysis; Patients; Pulsatile Flow; Renal resistive index; Sensitivity; Sensitivity and Specificity; Specificity; Statistical analysis; Studies; Ultrasonography, Doppler; Vascular Resistance; Ventilation; Doppler ultrasonography; OR; Critically ill; CI; Acute kidney injury; ROC; Renal resistive index; Sensitivity; Specificity; RDOR; RI; PI; ICU; AKI; relative diagnostic odds ratio; Doppler-based renal resistive index; pulsatility index; odds ratio; acute kidney injury; confidence interval; intensive care unit; receiver operating characteristic
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2015.02.008

Doppler-based renal resistive index (RI) might help in distinguishing transient from persistent acute kidney injury (AKI). The main objective of these systematic review and meta-analysis was to investigate the diagnostic performance of RI in predicting short-term reversibility of AKI. A systematic review of the literature was performed. Relevant studies were identified in Pubmed and Cochrane databases covering the years 1985 to 2013 and reviewed independently by 3 authors. Renal transplant recipients were excluded from this analysis. The summary estimates were computed using a random-effects model based on the DerSimonian and Lair meta-analytic method. Among the 154 unique articles identified, 9 studies were included. Of the 176 patients in these studies with elevated RI or pulsatility index, 146 (83%) had a persistent AKI vs 44 (16%) of the 273 patients with normal values. Elevated RI or pulsatility index was associated with an increased risk of persistent AKI (odds ratio, 29.85; 95% confidence interval [CI], 8.73-102.16; P < .00001) with significant heterogeneity (I2 = 75.0%, P < .0001). The pooled sensitivity and specificity were 0.83 (95% CI, 0.77-0.88) and 0.84 (95% CI, 0.79-0.88). The summary positive and negative likelihood ratios were 4.9 (95% CI, 2.44-9.87) and 0.21 (95% CI, 0.11-0.41). These results suggest that an elevated RI may be a predictor of persistent AKI in critically ill patients. Further studies are warranted, however, to clarify the exact test performance given the marked heterogeneity among the included studies.