Early Detection of Postoperative Acute Kidney Injury in Acute Stanford Type A Aortic Dissection With Doppler Renal Resistive Index.

OBJECTIVES: This study aimed to evaluate the early efficiency of Doppler renal resistive index (DRRI) in prediction of acute kidney injury (AKI) after surgery in acute Stanford Type A aortic dissection (AAAD) patients.

METHODS: Sixty-one AAAD patients who planned to receive Sun's surgical management were prospectively enrolled. The DRRI was measured by ultrasonography Doppler on the day before surgery (DRRIpre ), on admission to the intensive care unit (DRRIT0 ), 6 hours after surgery (DRRIT6 ), 24 hours after surgery (DRRIT24 ), and 48 hours after surgery (DRRIT48 ). The maximum DRRI value (DRRImax ) was recorded. The AKI was evaluated according to the classifications of the Acute Kidney Injury Network. The DRRI and serum creatinine (sCr) were compared between the pre- and postoperative time stations, as well as between the AKI and no-AKI groups.

RESULTS: Thirty-nine (63.9%) patients suffered from AKI, and 12 (19.6%) patients received dialysis. No significant difference was found in DRRIpre (0.63 ± 0.04 versus 0.65 ± 0.06, P = .059) and sCrpre (84.13 ± 23.77 versus 94.29 ± 51.11, P = .383) between the two groups with and without AKI. Both the DRRI and sCr increased significantly after surgery in the AKI groups (P < .001). However, the DRRI reached its maximum 6 hours after surgery, whereas the sCr reached its maximum after 24 hours. Both the DRRI and sCr improved 48 hours after surgery. The area under the receiver operating characteristic curve for DRRImax (0.864, 95% confidence interval: 0.770-0.957) and DRRIT6 (0.861, 95% confidence interval: 0.766-0.957) was larger than the other three DRRIs measured at different time points. The cutoff value of DRRImax was 0.71, a sensitivity of 76.9% and specificity of 95.5%.

CONCLUSIONS: Postoperative DRRI predicts the AKI earlier than sCr after AAAD surgery. The best time to detect DRRI was 6 hours after surgery.