Non-invasive Hemodynamic Monitoring of Fluid Resuscitation in Cirrhotic Patients with Acute Kidney Injury

  • Samir El Hadidy Department of Critical Care, Faculty of Medicine, Cairo University, Giza, Egypt
  • Ahmed Albadry Department of Critical Care Medicine, Theodor Bilharz Research Institute, Giza, Egypt
  • Waheed Radwan Department of Critical Care, Faculty of Medicine, Cairo University, Giza, Egypt
  • Amna Metwaly Department of Critical Care, Faculty of Medicine, Cairo University, Giza, Egypt
  • Khaled Farouk Department of Critical Care, Faculty of Medicine, Cairo University, Giza, Egypt
Keywords: Acute Kidney Injury, Fluid Resuscitation, Liver Cirrhosis, Non-invasive Hemodynamic Monitoring

Abstract

BACKGROUND: Fluid management of patients with liver cirrhosis and acute kidney injury (AKI) is a complex problem requiring accurate assessment of the intravascular volume status and the cause of the AKI. Echocardiography used in various hemodynamic monitoring as a quick, easy, bedside, and non-invasive tool with great sensitivity.

AIM: This study aims to evaluate echocardiography as a non-invasive hemodynamic monitoring tool for the assessment of volume status and cardiac function before and after volume expansion in patients with liver cirrhosis presented by AKI.

PATIENTS AND METHODS: This study included 120 patients with liver cirrhosis and AKI. All patients were subjected to clinical evaluation, laboratory assessment of kidney and liver functions, and echocardiographic assessment of inferior vena cava (IVC) collapsibility index, left ventricular outflow tract velocity time integral (LVOT VTI) variability index, and cardiac output (CO).

RESULTS: Comparison between responders and non-responders to volume resuscitation regarding the echocardiographic data showed that responders had significantly higher IVC collapsibility index, LVOT VTI variability index, and % of CO increase. IVC collapsibility index and LVOT VTI variability index showed good predictive value of fluid responsiveness.

CONCLUSIONS: The use of echocardiography is a good tool for hemodynamic monitoring of fluid resuscitation in cirrhotic patients with AKI. The use of echocardiography has limited the use of central venous line only to patients with hemodynamic instability requiring vasoactive support.

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References

Fernández J, Aracil C, Solà E, Soriano G, Cardona MC, Coll S, et al. Evaluation and treatment of the critically Ill cirrhotic patient. Gastroenterol Hepatol. 2016;39(9):607-26. https://doi. org/10.1016/j.gastre.2016.10.004 PMid:26778768

Olson JC. Intensive care management of patients with cirrhosis. Curr Treat Options Gastroenterol. 2018;16(2):241-52. PMid:29616404

Risør LM, Bendtsen F, Møller S. Immunologic, hemodynamic, and adrenal incompetence in cirrhosis: Impact on renal dysfunction. Hepatol Int. 2015;9(1):17-27. https://doi. org/10.1007/s12072-014-9581-1 PMid:25788375

Muciño-Bermejo J, Carrillo-Esper R, Uribe M, Méndez- Sánchez N. Acute kidney injury in critically Ill cirrhotic patients: A review. Ann Hepatol. 2012;11(3):301-10. https://doi.org/10.1016/ s1665-2681(19)30924-x PMid:22481447

Qasem AA, Farag SE, Hamed E, Emara M, Bihery A, Pasha H. Urinary biomarkers of acute kidney injury in patients with liver cirrhosis. ISRN Nephrol. 2014;2014:376795. https://doi. org/10.1155/2014/376795

El Sharkawy OA, Refaat EK, Ibraheem AE, Mahdy WR, Fayed NA, Mourad WS, et al. Transoesophageal Doppler compared to central venous pressure for perioperative hemodynamic monitoring and fluid guidance in liver resection. Saudi J Anaesth. 2013;7(4):378-86. https://doi. org/10.4103/1658-354x.121044 PMid:24348287

Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute kidney injury network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31. https://doi.org/10.1186/cc5713 PMid:17331245

Salerno F, Gerbes A, Ginès P, Wong F, Arroyo V. Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Gut. 2007;56(9):1310-8. https://doi.org/10.1136/ gut.2006.107789 PMid:17389705

Balogh Z, Jones F, D’Amours S, Parr M, Sugrue M. Continuous intra-abdominal pressure measurement technique. Am J Surg. 2004;188(6):679-84. https://doi.org/10.1016/j. amjsurg.2004.08.052 PMid:15619483

Messina A, Longhini F, Coppo C, Pagni A, Lungu R, Ronco C, et al. Use of the fluid challenge in critically Ill adult patients: A systematic review. Anesth Analg. 2017;125(5):1532-43. https:// doi.org/10.1213/ane.0000000000002103 PMid:28514324

Huggins JT, Doelken P, Walters C, Rockey DC. Point-of-care echocardiography improves assessment of volume status in cirrhosis and hepatorenal syndrome. Am J Med Sci. 2016;351(5):550-3. https://doi.org/10.1016/j. amjms.2016.02.040 PMid:27140719

Warner NS, Cuthbert JA, Bhore R, Rockey DC. Acute kidney injury and chronic kidney disease in hospitalized patients with cirrhosis. J Investig Med. 2011;59(8):1244-51. https://doi. org/10.2310/jim.0b013e3182321471 PMid:21941210

Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: A critical analysis of the evidence. Chest. 2002;121(6):2000-8. https://doi.org/10.1378/chest.121.6.2000 PMid:12065368

Miller A, Mandeville J. Predicting and measuring fluid responsiveness with echocardiography. Echo Res Pract. 2016;3(2):G1-12. https://doi.org/10.1530/erp-16-0008 PMid:27249550

Coen D, Cortellaro F, Pasini S, Tombini V, Vaccaro A, Montalbetti L, et al. Towards a less invasive approach to the early goal-directed treatment of septic shock in the ED. Am J Emerg Med. 2014;32(6):563-8. https://doi.org/10.1016/j. ajem.2014.02.011 PMid:24666743

Zhao J, Wang G. Inferior vena cava collapsibility index is a valuable and non-invasive index for elevated general heart end-diastolic volume index estimation in septic shock patients. Med Sci Monit. 2016;22:3843-8. https://doi.org/10.12659/ msm.897406 PMid:27762259

Gan H, Cannesson M, Chandler JR, Ansermino JM. Predicting fluid responsiveness in children: A systematic review. Anesth Analg. 2013;117(6):1380-92. https://doi.org/10.1213/ ane.0b013e3182a9557e PMid:24257389

De Lorenzo RA, Morris MJ, Williams JB, Haley TF, Straight TM, Holbrook-Emmons VL, et al. Does a simple bedside sonographic measurement of the inferior vena cava correlate to central venous pressure? J Emerg Med. 2012;42(4):429-36. https://doi. org/10.1016/j.jemermed.2011.05.082 PMid:22197199

Published
2020-06-11
How to Cite
1.
El Hadidy S, Albadry A, Radwan W, Metwaly A, Farouk K. Non-invasive Hemodynamic Monitoring of Fluid Resuscitation in Cirrhotic Patients with Acute Kidney Injury. Open Access Maced J Med Sci [Internet]. 2020Jun.11 [cited 2020Oct.31];8(B):319-23. Available from: https://www.id-press.eu/mjms/article/view/4337