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Renal resistive index and renal function before and after paracentesis in patients with hepatorenal syndrome and tense ascites

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Abstract

Objective

To assess the effect of reducing intra-abdominal pressure (IAP) by paracentesis on renal resistive index (RI), hemodynamics and renal function.

Design and setting

Uncontrolled trial in a university gastroenterological intensive care unit.

Patients

Twelve spontaneously breathing cirrhotic patients with hepatorenal syndrome, tense ascites and a clinical indication for paracentesis.

Interventions

Paracentesis and substitution of albumin.

Measurements and results

Hemodynamic variables were assessed by transpulmonary thermodilution, RI was determined by Doppler ultrasound of renal interlobar arteries. After paracentesis and albumin substitution, there was a significant decrease of IAP (20 mmHg (19–22) to 12 mmHg (10–13), systemic vascular resistance index (from 1,243 dyn s/cm5/m2 (1,095–1,745) to 939 dyn s/cm5/m2 (812–1,365); p = 0.005) and RI (from 0.848 (0.810–0.884) to 0.810 (0.780–0.826); p = 0.003). Arterial compliance increased from 1.33 mL/mmHg (0.89–1.74) to 1.71 mL/mmHg (1.21–2.12), pulse pressure index remained unchanged. Creatinine clearance (ClCreat) increased significantly from 5 mL/min (0–28) to 9 mL/min (0–36) (p = 0.018) and urinary output from 12 mL/h (0–49) to 16 mL/h (0–64) (p = 0.043).

Conclusions

In patients with cirrhosis, HRS and tense ascites, IAP may contribute to renal dysfunction. Reduction of IAP following paracentesis and albumin substitution may improve ClCreat, probably by improving renal blood flow as reflected by decreasing RI in Doppler ultrasound.

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Abbreviations

compa :

Arterial compliance

CVP:

Central venous pressure

CI:

Cardiac index

FG:

Filtration gradient

GEDVI:

Global end-diastolic volume index

HRS:

Hepatorenal syndrome

IAH:

Intra-abdominal hypertension

IAP:

Intra-abdominal pressure

MAP:

Mean arterial pressure

PPI:

Pulse pressure index

RI:

Resistive index

RPP:

Renal perfusion pressure

SVI:

Stroke volume index

SVRI:

Systemic vascular resistance index

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Conflict of interest statement

A. Umgelter and W. Huber have been invited speakers for Pulsion Medical Systems, Munich, Germany. The other authors declare no conflict of interest.

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Authors and Affiliations

  1. II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, Munich, Germany

    Andreas Umgelter, Wolfgang Reindl, Wolfgang Huber & Roland M. Schmid

  2. Universitätsklinik für Medizin I, Paracelsus Universität, Salzburg, Austria

    Michael Franzen

  3. Klinik für Nieren-, Hochdruck-, und Rheumakrankheiten, Klinikum Schwabing, Städtisches Klinikum München GmbH, Munich, Germany

    Cosima Lenhardt

Authors
  1. Andreas Umgelter
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  2. Wolfgang Reindl
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  3. Michael Franzen
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  4. Cosima Lenhardt
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  5. Wolfgang Huber
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  6. Roland M. Schmid
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Corresponding author

Correspondence to Andreas Umgelter.

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Umgelter, A., Reindl, W., Franzen, M. et al. Renal resistive index and renal function before and after paracentesis in patients with hepatorenal syndrome and tense ascites. Intensive Care Med 35, 152–156 (2009). https://doi.org/10.1007/s00134-008-1253-y

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  • DOI: https://doi.org/10.1007/s00134-008-1253-y

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