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

Intensive Care Med (2009) 35:152156DOI 10.1007/s00134-008-1253-y BRIEF REPORT

Andreas Umgelter Wolfgang Reindl Michael Franzen Cosima Lenhardt Wolfgang Huber Roland M. Schmid

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

Received: 19 June 2008Accepted: 17 August 2008 Published online: 18 September 2008 Springer-Verlag 2008

A. Umgelter ()) W. Reindl W. Huber

R. M. SchmidII. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germanye-mail: [email protected]. deTel.: ?49-89-41402265Fax: ?49-89-41404808

M. FranzenUniversitatsklinik fr Medizin I, Paracelsus Universitat, Salzburg, Austria

C. LenhardtKlinik fr Nieren-, Hochdruck-, und Rheumakrankheiten, Klinikum Schwabing, Stadtisches Klinikum Mnchen GmbH, Munich, Germany

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 signicant decrease of IAP(20 mmHg (1922) to 12 mmHg (1013), systemic vascular resistance index (from 1,243 dyn s/cm5/m2 (1,0951,745) to 939 dyn s/cm5/m2 (8121,365); p = 0.005) and RI (from 0.848 (0.8100.884) to 0.810(0.7800.826); p = 0.003). Arterial compliance increased from 1.33 mL/ mmHg (0.891.74) to 1.71 mL/ mmHg (1.212.12), pulse pressure index remained unchanged. Creati-nine clearance (ClCreat) increased signicantly from 5 mL/min (028) to 9 mL/min (036) (p = 0.018) and urinary output from 12 mL/h (049) to 16 mL/h (064) (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 ow as reected by decreasing RI in Doppler ultrasound.

Keywords Hepatorenal syndrome

Intra-abdominal hypertension

Renal resistive index Paracentesis

Ascites

Abbreviations

compa Arterial compliance CVP Central venous pressure CI Cardiac indexFG Filtration gradient GEDVI Global end-diastolic volume indexHRS Hepatorenal syndrome IAH Intra-abdominal hypertensionIAP Intra-abdominal pressure MAP Mean arterial pressure PPI Pulse pressure indexRI Resistive indexRPP Renal perfusion pressure SVI Stroke volume index SVRI Systemic vascular resistance index

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Introduction

According to...