Right Ventricular Function, Peripheral Edema, and Acute Kidney Injury in Critical Illness
Introduction The cardiorenal syndrome generally focuses on left ventricular function, and the importance of the right ventricle as a determinant of renal function is described less frequently. In a cohort of critically ill patients with echocardiographic measurements obtained within 24 hours of admi...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier BV
2020
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| Online Access: | https://hdl.handle.net/1721.1/126425 |
| _version_ | 1811083854736261120 |
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| author | Chen, Christina Lee, Joon Johnson, Alistair Edward William Mark, Roger G Celi, Leo Anthony G. Danziger, John |
| author2 | Harvard University--MIT Division of Health Sciences and Technology |
| author_facet | Harvard University--MIT Division of Health Sciences and Technology Chen, Christina Lee, Joon Johnson, Alistair Edward William Mark, Roger G Celi, Leo Anthony G. Danziger, John |
| author_sort | Chen, Christina |
| collection | MIT |
| description | Introduction The cardiorenal syndrome generally focuses on left ventricular function, and the importance of the right ventricle as a determinant of renal function is described less frequently. In a cohort of critically ill patients with echocardiographic measurements obtained within 24 hours of admission to the intensive care unit, we examined the association of right ventricular function with acute kidney injury (AKI) and AKI-associated mortality. We also examined whether clinical measurement of volume overload modified the association between ventricular function and AKI in a subpopulation with documented admission physical examinations. Methods Among 1879 critically ill patients with echocardiographic ventricular measurements, 43% (n = 807) had ventricular dysfunction—21% (n = 388), 9% (n = 167), and 13% (n = 252) with isolated left ventricular dysfunction, isolated right ventricular dysfunction, and biventricular dysfunction, respectively. Overall, ventricular dysfunction was associated with a 43% higher adjusted risk of AKI (95% confidence interval [CI] 1.14–1.80; P = 0.002) compared with those with normal biventricular function, whereas isolated left ventricular dysfunction, isolated right ventricular dysfunction, and biventricular dysfunction were associated with a 1.34 (95% CI 1.00-1.77, P = 0.05), 1.35 (95% CI 0.90–2.10, P = 0.14) and 1.67 (95% CI 1.23–2.31, P = 0.002) higher adjusted risk. Although an episode of AKI was associated with an approximately 2-fold greater risk of hospital mortality in those with isolated left ventricular dysfunction and biventricular dysfunction, in those with isolated right ventricular dysfunction, AKI was associated with a 7.85-fold greater risk of death (95% CI 2.89–21.3, P < 0.001). Independent of ventricular function, peripheral edema was an important determinant of AKI. Discussion Like left ventricular function, right ventricular function is an important determinant of AKI and AKI-associated mortality. Volume overload, independently of ventricular function, is a risk factor for AKI. Whether establishment of euvolemia might mitigate AKI risk will require further study. |
| first_indexed | 2024-09-23T12:40:27Z |
| format | Article |
| id | mit-1721.1/126425 |
| institution | Massachusetts Institute of Technology |
| language | English |
| last_indexed | 2024-09-23T12:40:27Z |
| publishDate | 2020 |
| publisher | Elsevier BV |
| record_format | dspace |
| spelling | mit-1721.1/1264252022-10-01T10:27:11Z Right Ventricular Function, Peripheral Edema, and Acute Kidney Injury in Critical Illness Chen, Christina Lee, Joon Johnson, Alistair Edward William Mark, Roger G Celi, Leo Anthony G. Danziger, John Harvard University--MIT Division of Health Sciences and Technology Introduction The cardiorenal syndrome generally focuses on left ventricular function, and the importance of the right ventricle as a determinant of renal function is described less frequently. In a cohort of critically ill patients with echocardiographic measurements obtained within 24 hours of admission to the intensive care unit, we examined the association of right ventricular function with acute kidney injury (AKI) and AKI-associated mortality. We also examined whether clinical measurement of volume overload modified the association between ventricular function and AKI in a subpopulation with documented admission physical examinations. Methods Among 1879 critically ill patients with echocardiographic ventricular measurements, 43% (n = 807) had ventricular dysfunction—21% (n = 388), 9% (n = 167), and 13% (n = 252) with isolated left ventricular dysfunction, isolated right ventricular dysfunction, and biventricular dysfunction, respectively. Overall, ventricular dysfunction was associated with a 43% higher adjusted risk of AKI (95% confidence interval [CI] 1.14–1.80; P = 0.002) compared with those with normal biventricular function, whereas isolated left ventricular dysfunction, isolated right ventricular dysfunction, and biventricular dysfunction were associated with a 1.34 (95% CI 1.00-1.77, P = 0.05), 1.35 (95% CI 0.90–2.10, P = 0.14) and 1.67 (95% CI 1.23–2.31, P = 0.002) higher adjusted risk. Although an episode of AKI was associated with an approximately 2-fold greater risk of hospital mortality in those with isolated left ventricular dysfunction and biventricular dysfunction, in those with isolated right ventricular dysfunction, AKI was associated with a 7.85-fold greater risk of death (95% CI 2.89–21.3, P < 0.001). Independent of ventricular function, peripheral edema was an important determinant of AKI. Discussion Like left ventricular function, right ventricular function is an important determinant of AKI and AKI-associated mortality. Volume overload, independently of ventricular function, is a risk factor for AKI. Whether establishment of euvolemia might mitigate AKI risk will require further study. National Institute of Biomedical Imaging and Bioengineering (Grant R01-EB017205) 2020-07-28T22:01:28Z 2020-07-28T22:01:28Z 2017-06 2019-10-09T15:41:12Z Article http://purl.org/eprint/type/JournalArticle 2468-0249 https://hdl.handle.net/1721.1/126425 Chen, Christina et al. "Right Ventricular Function, Peripheral Edema, and Acute Kidney Injury in Critical Illness." Clinical Research 2, 6 (November 2017): P1059-1065 © 2017 International Society of Nephrology en http://dx.doi.org/10.1016/j.ekir.2017.05.017 Kidney International Reports Creative Commons Attribution-NonCommercial-NoDerivs License http://creativecommons.org/licenses/by-nc-nd/4.0/ application/pdf Elsevier BV Elsevier |
| spellingShingle | Chen, Christina Lee, Joon Johnson, Alistair Edward William Mark, Roger G Celi, Leo Anthony G. Danziger, John Right Ventricular Function, Peripheral Edema, and Acute Kidney Injury in Critical Illness |
| title | Right Ventricular Function, Peripheral Edema, and Acute Kidney Injury in Critical Illness |
| title_full | Right Ventricular Function, Peripheral Edema, and Acute Kidney Injury in Critical Illness |
| title_fullStr | Right Ventricular Function, Peripheral Edema, and Acute Kidney Injury in Critical Illness |
| title_full_unstemmed | Right Ventricular Function, Peripheral Edema, and Acute Kidney Injury in Critical Illness |
| title_short | Right Ventricular Function, Peripheral Edema, and Acute Kidney Injury in Critical Illness |
| title_sort | right ventricular function peripheral edema and acute kidney injury in critical illness |
| url | https://hdl.handle.net/1721.1/126425 |
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