Abstract
Abstract BACKGROUND AND AIMS Microcirculation plays a critical role in the development of sepsis-associated acute kidney injury (S-AKI); however, it remains uncertain whether microcirculatory dysfunction influences recovery. We investigated the association of contrast-enhanced ultrasound (CEUS)-assessed microcirculatory parameters with dialysis dependence in patients with S-AKI receiving renal replacement therapy. METHOD This study included 23 patients who underwent renal replacement therapy due to S-AKI, in addition to 17 healthy individuals and 18 subjects with chronic kidney disease (CKD). Parameters obtained from CEUS were compared. RESULTS Of the CEUS-derived parameters, patients with S-AKI had delayed rise time, time to peak and fall time, compared with healthy individuals (P = .039, .045 and .072), but they had similar values of peak enhancement, wash-in/out area under the curve (AUC), and wash-in perfusion index. Parameters did not differ between the S-AKI and CKD groups. Among patients with S-AKI, 10 (43.5%) patients did not experience renal recovery and required the lifelong dialysis treatment. They had lower values of peak enhancement, wash-in/out AUC, and wash-in perfusion index than in those with recovered renal function (P = .049, .021, .036 and .049). In addition, these values were slightly related to renal recovery after the adjustment with age, sex and disease severity (P = .096, .065, .094 and .072, respectively). We further evaluated the receiver operating characteristic curve and observed that CEUS-derived peak enhancement, wash-in/out AUC, and wash-in perfusion index predicted renal recovery (P = .047, .022, .035 and .047). CONCLUSION Assessment of microcirculatory alterations using CEUS may help to predict the probability of renal recovery in patients with S-AKI receiving renal replacement therapy. Further studies are needed to confirm the utility of CEUS, in consideration with baseline renal function and pathologic findings.
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