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Abstract Aims Worsening of renal function (WRF) is a common complication in patients with acute decompensated heart failure (ADHF). We aimed to evaluate the role of intrarenal Doppler ultrasound (IRD) in the early prediction of WRF in this patient group. Methods and results Among 90 patients (age: 57.5 ± 11.1 years; 62% male) hospitalized with ADHF, resistivity index (RI), acceleration time (AT), and pulsatility index (PI) were measured on admission and at 24 and 72 h. WRF was defined as increased serum creatinine ≥0.3 mg/dL from baseline. Adverse clinical outcomes were defined as the composite of death, use of vasopressors, and need for ultrafiltration for refractory oedema. WRF developed in 40% of patients. Mean values of renal AT, RI, and PI on admission were 59.7 ± 15, 0.717 ± 0.08, and 1.5 ± 0.48 ms, respectively. At 24 h, there was significant decrease in AT (to 56.7 ± 10 ms, P = 0.02) and renal RI (to 0.732 ± 0.07; P

The diagnosis of diabetic kidney disease can be delayed by limitations of primary biomarkers, which are microalbuminuria and estimated glomerular filtration rate. A number of Doppler ultrasound studies have associated an increase in intrarenal vascular resistance with the disease, which makes ultrasound a potential adjunct tool for early diagnosis. However, there is inadequate evidence to establish the effectiveness of including Doppler ultrasound in the diagnostic process. This systematic review was therefore conducted to determine the value of using Doppler ultrasound in early detection of diabetic kidney disease. Electronic literature searches were carried out in PubMed, CINAHL, Web of Science and EMBASE. All published prospective studies with records of intrarenal Doppler ultrasound, microalbuminuria and estimated glomerular filtration rate were obtained, and their relationship as parameters for diabetic kidney disease assessed. The meta-analysis of Doppler ultrasound versus albuminuria shows insignificant statistical difference between high resistive index of ≥ 0.7 and albuminuria, with the resistive index being the favoured parameter on the forest plot, making Doppler ultrasound highly comparable with albuminuria for the detection of diabetic kidney disease. Again, there was a significant statistical difference between high intrarenal resistive index of ≥ 0.7 and low estimated glomerular filtration rate of < 60 mL/min/1.73 m2, with the resistive index being the favoured parameter on the forest plot, making Doppler ultrasound a superior parameter compared with estimated glomerular filtration rate for early detection of diabetic kidney disease. [ABSTRACT FROM AUTHOR]

Aims: Worsening of renal function (WRF) is a common complication in patients with acute decompensated heart failure (ADHF). We aimed to evaluate the role of intrarenal Doppler ultrasound (IRD) in the early prediction of WRF in this patient group. Methods and results: Among 90 patients (age: 57.5 ± 11.1 years; 62% male) hospitalized with ADHF, resistivity index (RI), acceleration time (AT), and pulsatility index (PI) were measured on admission and at 24 and 72 h. WRF was defined as increased serum creatinine ≥0.3 mg/dL from baseline. Adverse clinical outcomes were defined as the composite of death, use of vasopressors, and need for ultrafiltration for refractory oedema. WRF developed in 40% of patients. Mean values of renal AT, RI, and PI on admission were 59.7 ± 15, 0.717 ± 0.08, and 1.5 ± 0.48 ms, respectively. At 24 h, there was significant decrease in AT (to 56.7 ± 10 ms, P = 0.02) and renal RI (to 0.732 ± 0.07; P < 0.001); these changes were maintained up to 72 h. Renal PI showed no significant changes. Independent predictors of WRF were renal AT at 24 h and admission values of renal RI, left ventricular ejection fraction, and plasma cystatin C. Renal AT at 24 h ≥ 57.8 ms had 89% sensitivity and 70% specificity for the prediction of WRF. Independent predictors for adverse clinical outcomes were left ventricular end systolic dimension and WRF. Conclusions: Among ADHF patients receiving diuretic therapy, measurement of renal AT and RI by IRD can help identify patients at increased risk for WRF. [ABSTRACT FROM AUTHOR]