• Hui Zhang, Kang Zhou, Dongyue Wang, Na Zhang, and Jindong Liu.
• Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
• Minerva Anestesiol. 2020 Nov 1; 86 (11): 1161-1169.

BackgroundThe incidence of cardiac surgery-associated acute kidney injury (CSA-AKI) is very high. The Renal Resistive Index (RRI) is measured by transesophageal echocardiography (TEE) and can be used to predict the occurrence of CSA-AKI, but few studies have examined the Renal Pulsatility Index (RPI). The objective of this study was to explore the predictive value of intraoperative RPI for CSA-AKI.MethodsThis study was a prospective observational study. Seventy-eight patients meeting the inclusion criteria were enrolled. The RPI was measured by TEE after the induction of general anesthesia (T1) and immediately after the surgery (T2). Serum creatinine (Scr) was measured one day before and seven days after the surgery. The diagnosis of AKI was based on the KDIGO diagnostic criteria. Multivariate logistic regression analysis was used to analyze the risk factors for postoperative AKI and to draw the receiver operating characteristic curve (ROC) and analyze its diagnostic value for AKI.ResultsThe incidence of postoperative AKI was 29.5%. The RPI at T2 was higher in the AKI group than in the non-AKI group (2.05±0.69 versus 1.49±0.48, P<0.001). The results of multivariate analysis showed that the RPI at T2 was an independent risk factor for the occurrence of AKI (OR=4.683, 95% CI: 1.592-13.772; P=0.006). The area under the curve (AUC) of the RPI was 0.733 (95% CI: 0.621-0.827) with a cut-off value of 1.86 (sensitivity 60.87%, specificity 85.45% and Youden Index 0.46).ConclusionsAn RPI at T2>1.86 is correlated with a higher incidence of postoperative AKI. Treatment guided and personalized on the base of this parameter should be investigated by further dedicated studies.

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