Renal failure in critically ill patients, beware of applying (central venous) pressure on the kidney

Chen, Xiukai; Wang, Xiaoting; Honoré, Patrick M.; Spapen, Herbert D.; Liu, Dawei

doi:10.1186/s13613-018-0439-x

Cited by 53 publications

(54 citation statements)

References 63 publications

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“…Elevated CVP correlated with AKI as corroborated by a meta-analysis done by Chen et al 11 Central venous pressure did not normalize in those patients with AKI resolution showing CVP trend might not truly reflect the clinical picture because of its limitations, and possibly also because different patients may have different levels of tolerance of CVP, whereas Doppler flow markers may better reflect the severity of organ congestion and potential dysfunction. Peripheral signs of fluid overload did not correlate with AKI, which reemphasizes the fact that they might not truly reflect the intravascular volume status.…”

Section: Discussionmentioning

confidence: 86%

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Combination of Inferior Vena Cava Diameter, Hepatic Venous Flow, and Portal Vein Pulsatility Index: Venous Excess Ultrasound Score (VEXUS Score) in Predicting Acute Kidney Injury in Patients with Cardiorenal Syndrome: A Prospective Cohort Study

Bhardwaj

Gunaseelan

Rola³

et al. 2020

Indian Journal of Critical Care Medicine

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A bstract Background Fluid overload is deleterious in critically ill patients. It can lead to venous congestion, thereby increasing venous pressure, theoretically increasing the backpressure, and thereby reducing renal blood flow. Venous congestion thus can be an important contributor to acute kidney injury (AKI), with no validated tools to objectively identify venous congestion bedside. Materials and methods Patients above 18 years admitted in ICU with a provisional diagnosis of cardiorenal syndrome were included in the study. Those with inadequate window, inferior vena cava (IVC) thrombus, and known case of cirrhosis with portal hypertension were excluded from the study. Patients underwent ultrasound examination with serial determination till AKI resolved or patient is initiated on dialysis. Venous excess ultrasound score (VEXUS) comprising inferior vena cava, hepatic vein waveform, and portal vein pulsatility was assessed. Results Thirty patients were enrolled for the study. The mean age was 59.53 ± 16.47 with 21 (70%) males. Mean sequential organ failure assessment (SOFA) score was 5.03 ± 1.97. Fourteen patients (46.7%) were in AKI stage 1, while eight patients (26.7%) were in AKI stage 2 and stage 3 each. Twenty patients (66.7%) had VEXUS grade III. Resolution of AKI injury showed significant correlation with improvement in VEXUS grade ( p value 0.003). Similarly, there was significant association between changes in VEXUS grade and fluid balance ( p value 0.006). There was no correlation between central venous pressure (CVP), left ventricular function, and right ventricular function with change in VEXUS grade. Conclusion The study shows that a combined grading of IVC, hepatic vein, and portal vein might reliably demonstrate venous congestion and aid in the clinical decision to perform fluid removal. How to cite this article Bhardwaj V, Vikneswaran G, Rola P, Raju S, Bhat RS, Jayakumar A, et al. Combination of Inferior Vena Cava Diameter, Hepatic Venous Flow, and Portal Vein Pulsatility Index: Venous Excess Ultrasound Score (VEXUS Score) in Predicting Acute Kidney Injury in Patients with Cardiorenal Syndrome: A Prospective Cohort Study. Indian J Crit Care Med 2020;24(9):783–789.

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Section: Discussionmentioning

confidence: 86%

“… 10 A case series published by Denault et al on post-cardiac surgery patients showed portal vein Doppler assessment to be a promising modality for end-organ venous congestion in post-cardiac surgery patients. 11 Portal vein is subjected to variation because of body habitus and intrathoracic pressure. 12 , 13 …”

Section: B Ackgroundmentioning

confidence: 99%

Combination of Inferior Vena Cava Diameter, Hepatic Venous Flow, and Portal Vein Pulsatility Index: Venous Excess Ultrasound Score (VEXUS Score) in Predicting Acute Kidney Injury in Patients with Cardiorenal Syndrome: A Prospective Cohort Study

Bhardwaj

Gunaseelan

Rola³

et al. 2020

Indian Journal of Critical Care Medicine

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“…Based on the rationale provided by the Starling curves and Guyton theory on cardiac function [4], high CVP may impede venous return to the heart and disturb microcirculatory blood flow which may harm organ function, lead to poor prognosis, and even increase mortality. Moreover, elevated CVP will particularly harm kidney hemodynamic and promote acute kidney injury (AKI) by imposing an increased "afterload" on the kidney [5]. However, the association between CVP and mortality and AKI in critically ill patients remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Elevated central venous pressure is associated with increased mortality and acute kidney injury in critically ill patients: a meta-analysis

Chen¹,

Zhou²,

Wang³

et al. 2020

Crit Care

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Background: The association of central venous pressure (CVP) and mortality and acute kidney injury (AKI) in critically ill adult patients remains unclear. We performed a meta-analysis to determine whether elevated CVP is associated with increased mortality and AKI in critically ill adult patients. Methods: We searched PubMed and Embase through June 2019 to identify studies that investigated the association between CVP and mortality and/or AKI in critically ill adult patients admitted into the intensive care unit. We calculated the summary odds ratio (OR) and 95% CI using a random-effects model. Results: Fifteen cohort studies with a broad spectrum of critically ill patients (mainly sepsis) were included. On a dichotomous scale, elevated CVP was associated with an increased risk of mortality (3 studies; 969 participants; OR, 1.65; 95% CI, 1.19-2.29) and AKI (2 studies; 689 participants; OR, 2.09; 95% CI, 1.39-3.14). On a continuous scale, higher CVP was associated with greater risk of mortality (5 studies; 7837 participants; OR, 1.10; 95% CI, 1.03-1.17) and AKI (6 studies; 5446 participants; OR, 1.14; 95% CI, 1.06-1.23). Furthermore, per 1 mmHg increase in CVP increased the odds of AKI by 6% (4 studies; 5150 participants; OR, 1.06; 95% CI, 1.01-1.12). Further analyses restricted to patients with sepsis showed consistent results. Conclusions: Elevated CVP is associated with an increased risk of mortality and AKI in critically ill adult patients admitted into the intensive care unit.

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“…Surgical treatment for severe tricuspid regurgitation may occasionally be delayed until the onset of right‐sided heart failure with end‐organ damage. Elevated central venous pressure secondary to right‐sided heart failure leads to chronic renal failure, which consequently increases perioperative mortality 7,8 . In our opinion, in the present case, chronic end‐organ damage and right‐sided heart failure contributed to postoperative hemodynamic, respiratory, and renal deterioration.…”

Section: Discussionmentioning

confidence: 56%

Enlarged coronary sinus thrombosis after repair of Ebstein's anomaly

et al. 2020

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A 58‐year‐old woman was referred to our hospital with progressively increasing breathlessness. She reported a history of bioprosthetic valve implantation for tricuspid valve replacement and direct closure of an atrial septal defect for Ebstein's anomaly, 31 years before presentation. Transthoracic echocardiography revealed prosthetic valve failure, an enlarged coronary sinus, and severe mitral regurgitation. Computed tomography revealed a giant coronary sinus with thrombosis and persistent left superior vena cava. She underwent successful mitral and tricuspid valve replacement; however, severe hemodynamic deterioration necessitated mechanical ventilatory support with extracorporeal membrane oxygenation.

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Renal failure in critically ill patients, beware of applying (central venous) pressure on the kidney

Cited by 53 publications

References 63 publications

Combination of Inferior Vena Cava Diameter, Hepatic Venous Flow, and Portal Vein Pulsatility Index: Venous Excess Ultrasound Score (VEXUS Score) in Predicting Acute Kidney Injury in Patients with Cardiorenal Syndrome: A Prospective Cohort Study

Combination of Inferior Vena Cava Diameter, Hepatic Venous Flow, and Portal Vein Pulsatility Index: Venous Excess Ultrasound Score (VEXUS Score) in Predicting Acute Kidney Injury in Patients with Cardiorenal Syndrome: A Prospective Cohort Study

Elevated central venous pressure is associated with increased mortality and acute kidney injury in critically ill patients: a meta-analysis

Enlarged coronary sinus thrombosis after repair of Ebstein's anomaly

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