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Kidney Week

Abstract: PO0267

Utility of a Point-of-Care Ultrasound Volume Assessment for Emergency Department Patients with AKI: A Pilot Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Lindsay-McGinn, Forrest F., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Moore, Christy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Kramer, Jeffrey A., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Panebianco, Nova, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Teran, Felipe, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Reisinger, Nathaniel C., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
Background

Acute kidney injury (AKI) identified in the emergency department (ED) portends worse in-hospital outcomes for patients. Point-of-care ultrasound (POCUS) for AKI is recommended to rule out obstructive uropathy but does not routinely include volume assessment, which may be informative regarding the underlying cause of AKI. POCUS evaluation of heart and lungs has proven to be useful in assessing intravascular volume status in patients on dialysis and with heart failure. This study aims to describe the clinical and ultrasonographic characteristics of patients with AKI using a POCUS volume assessment.

Methods

This is a prospective convenience sample of adult patients presenting to an academic, urban ED found to have AKI from September 2020 to May 2021. Ultrasounds were performed using 8-point lung, 5-point cardiac, kidney and bladder views. The diagnosis of AKI was established by Kidney Disease Improving Global Outcomes criteria. US images were obtained and interpreted by an US fellowship trained emergency medicine physician. The institutional review board approved this study.

Results

Thirty-seven patients were included. 22 were African American and 20 were male. Median age was 63 and average BMI was 29. Eight had documented CKD, 15 had diabetes, 24 had hypertension and 13 had heart failure. Prior to ultrasound assessment, 24 patients were assessed as hypovolemic, 4 as euvolemic, and 9 as hypervolemic by their emergency physician. Fifteen experienced stage 1 AKI, 5 had stage 2 AKI, and 17 had stage 3 AKI. Seven required dialysis during their admission. Two were found to have a bladder outlet obstruction and 4 were found to have bilateral, moderate to severe hydronephrosis. Thirty-seven had a left ventricular ejection fraction (EF) assessment, 21 had an EF >55%, 10 had an EF 30-55%% and 6 had an EF <30%. Four had right ventricular dilation. Thirteen had bilateral pulmonary B-lines suggestive of pulmonary edema. Thirty-six had an assessment of their inferior vena cava (IVC) and 15 had an IVC >15mm with less than 50% respiratory collapse.

Conclusion

Our study describes the findings of a POCUS volume assessment of ED patients with AKI. Abnormal cardiac and lung findings were common and may be a useful adjunct to IVC, kidney and bladder assessment alone.