Application value of right heart ultrasound combined with renal vascular doppler score in patients with end-stage renal disease during dialysis

doi:10.3969/j.issn.1004-583X.2025.01.008

Abstract

Abstract:

Objective To explore the value of right heart ultrasound index combined with renal vascular doppler score (RVDS) in evaluating the need for re-dialysis in patients with end-stage renal disease (ESRD). Methods According to the need for re-dialysis, 46 patients diagnosed as ESRD during dialysis were divided into the dialysis and control groups. Right heart ultrasound index was recorded by bedside ultrasonography, and the RVDS of bilateral kidneys was recorded. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic efficacy of each parameter. The correlation of RVDS with glomerular filtration rate and creatinine was analyzed. Results Compared with the control group, ESRD patients in the dialysis group had significantly higher right ventricular diameter (RVD), maximum tricuspid regurgitation velocity, pulmonary arterial systolic pressure, interventricular septal eccentricity index, and lower tricuspid annular plane systolic excursion (TAPSE), maximum velocity of tricuspid annulus contraction (S’), right-side RVDS (R-RVDS) and left-side RVDS (L-RVDS)(P<0.05). The area under the curve (AUC) of RVD, interventricular septal eccentricity index, TAPSE, S’, maximum tricuspid regurgitation velocity, pulmonary arterial systolic pressure and R-RVDS was 0.765, 0.750, 0.770, 0.780, 0.707, 0.723 and 0.682, respectively. TAPSE combined with R-RVDS had a sensitivity of 92.0%, specificity of 76.2% and AUC value of 0.850. Correlation analysis showed that R-RVDS and L-RVDS were positively correlated with glomerular filtration rate (r=0.514 and 0.544, respectively), but negatively correlated with creatinine (r=-0.337 and -0.484, respectively). Conclusion Right heart ultrasound index combined with renal vascular doppler score has higher evaluation and predictive value for patients who need re-dialysis with end-stage renal disease.

Key words: kidney failure, chronic, ultrasonography, doppler, renal dialysis, renal vascular, right heart function

CLC Number:

R692.5

Liu Yi, Zhao Haotian, Wang Xiaona, Liu Yuanlin, Li Li, Wang Zekai. Application value of right heart ultrasound combined with renal vascular doppler score in patients with end-stage renal disease during dialysis[J]. Clinical Focus, 2025, 40(1): 54-59.

Add to citation manager EndNote|Ris|BibTeX

URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2025.01.008

https://huicui.hebmu.edu.cn/EN/Y2025/V40/I1/54

Figures/Tables 6

Fig.1 Measurement of ultrasound parameters of right heart function a. the systolic displacement of TAPSE was 11.3 mm; b. the maximum return velocity of the tricuspid valve was 3.3 m/s, and the pulmonary artery systolic pressure was 53 mmHg via Bernoulli equation method (1 mmHg=0.133 kPa)

Fig.2 Short-axis eccentric indices measurements of the left ventricle a. the short axis ultrasound section with eccentricity index=transverse diameter (yellow line) / longitudinal diameter (blue line) was 0.97 in the control group; b. which was 1.39 in the dialysis group

Tab.1 Baseline data between the two groups

指标	例数		年龄 (岁)	性别[例(%)]				BMI (kg/m²)	心率 (次/min)		收缩压 (mmHg)		舒张压 (mmHg)
指标	例数		年龄 (岁)	男		女		BMI (kg/m²)	心率 (次/min)		收缩压 (mmHg)		舒张压 (mmHg)
需透析组	21		58.81±17.38	13(61.9)		8(38.1)		23.95(2.56)	89.71±17.01		145.76±21.07		84.38±15.28
对照组	25		53.20±14.57	17(68.0)		8(32.0)		25.62(6.89)	86.68±14.47		152.68±20.93		87.88±12.47
统计值			$t$ =1.191	χ²=0.187				$Z$ =-1.533	$t$ =0.654		$t$ =-1.113		$t$ =-0.856
$P$ 值			0.240	0.665				0.125	0.517		0.272		0.397
指标		肾小球滤过率 (ml/min)			肌酐 (μmol/L)		WBC (×10⁹/L)			NEUT (%)		下肢水肿 [例(%)]
需透析组		7.29±2.98			569.60(410.25)		8.18(5.80)			81.90(11.40)		8(38.1)
对照组		8.53±3.24			528.00(372.92)		6.98(1.83)			80.20(13.70)		12(48.0)
统计值		$t$ =-1.340			$Z$ =-0.827		$Z$ =-0.783			$Z$ =-0.805		χ²=0.456
$P$ 值		0.187			0.408		0.434			0.421		0.500

Tab.1 Baseline data between the two groups

指标	例数		年龄 (岁)	性别[例(%)]				BMI (kg/m²)	心率 (次/min)		收缩压 (mmHg)		舒张压 (mmHg)
指标	例数		年龄 (岁)	男		女		BMI (kg/m²)	心率 (次/min)		收缩压 (mmHg)		舒张压 (mmHg)
需透析组	21		58.81±17.38	13(61.9)		8(38.1)		23.95(2.56)	89.71±17.01		145.76±21.07		84.38±15.28
对照组	25		53.20±14.57	17(68.0)		8(32.0)		25.62(6.89)	86.68±14.47		152.68±20.93		87.88±12.47
统计值			$t$ =1.191	χ²=0.187				$Z$ =-1.533	$t$ =0.654		$t$ =-1.113		$t$ =-0.856
$P$ 值			0.240	0.665				0.125	0.517		0.272		0.397
指标		肾小球滤过率 (ml/min)			肌酐 (μmol/L)		WBC (×10⁹/L)			NEUT (%)		下肢水肿 [例(%)]
需透析组		7.29±2.98			569.60(410.25)		8.18(5.80)			81.90(11.40)		8(38.1)
对照组		8.53±3.24			528.00(372.92)		6.98(1.83)			80.20(13.70)		12(48.0)
统计值		$t$ =-1.340			$Z$ =-0.827		$Z$ =-0.783			$Z$ =-0.805		χ²=0.456
$P$ 值		0.187			0.408		0.434			0.421		0.500

Tab.2 Ultrasound parameters between the two groups

指标	例数	RVD (mm)	TAPSE (mm)	S’ (cm/s)	室间隔偏心指数	三尖瓣最大反流速度 (m/s)	肺动脉收缩压 (mmHg)	R-RVDS (分)	L-RVDS (分)
需透析组	21	36.43±5.55	15.19±3.02	12.35±2.52	1.06(0.12)	3.00±0.81	47.00(26.50)	1.26±0.26	1.36±0.32
对照组	25	31.76±4.42	17.86±1.89	14.79±2.13	1.02(0.05)	2.57±0.45	35.00(15.00)	1.54±0.43	1.60±0.46
统计值		$t$ =3.178	$t$ =-3.512	$t$ =-3.566	$Z$ =-2.902	$t$ =2.149	$Z$ =-2.583	$t$ =-2.594	$t$ =-2.109
$P$ 值		0.003	0.001	0.001	0.004	0.040	0.010	0.013	0.041

Tab.2 Ultrasound parameters between the two groups

指标	例数	RVD (mm)	TAPSE (mm)	S’ (cm/s)	室间隔偏心指数	三尖瓣最大反流速度 (m/s)	肺动脉收缩压 (mmHg)	R-RVDS (分)	L-RVDS (分)
需透析组	21	36.43±5.55	15.19±3.02	12.35±2.52	1.06(0.12)	3.00±0.81	47.00(26.50)	1.26±0.26	1.36±0.32
对照组	25	31.76±4.42	17.86±1.89	14.79±2.13	1.02(0.05)	2.57±0.45	35.00(15.00)	1.54±0.43	1.60±0.46
统计值		$t$ =3.178	$t$ =-3.512	$t$ =-3.566	$Z$ =-2.902	$t$ =2.149	$Z$ =-2.583	$t$ =-2.594	$t$ =-2.109
$P$ 值		0.003	0.001	0.001	0.004	0.040	0.010	0.013	0.041

Tab.3 Predictive value of each index for predicting ESRD patients

	AUC	$P$ 值	95% $C I$		敏感度	特异度	界值
	AUC	$P$ 值	下限	上限	敏感度	特异度	界值
RVD	0.765(0.621~0.908)	0.002	0.621	0.908	76.2	76.0	33.50
室间隔偏心指数	0.750(0.607~0.892)	0.004	0.607	0.892	66.7	72.0	1.035
TAPSE	0.770(0.626~0.913)	0.002	0.626	0.913	92.0	61.9	15.50
S’	0.780(0.640~0.920)	0.001	0.640	0.920	76.0	76.2	13.55
三尖瓣最大反流速度	0.707(0.543~0.870)	0.017	0.543	0.870	71.4	72.0	2.75
肺动脉收缩压	0.723(0.563~0.883)	0.010	0.563	0.883	81.0	68.0	37.50
R-RVDS	0.682(0.529~0.835)	0.035	0.529	0.835	32.0	100.0	1.75
L-RVDS	0.654(0.495~0.813)	0.074	0.495	0.813	44.0	90.5	1.75
TAPSE联合R-RVDS	0.850(0.736~0.963)	<0.001	0.736	0.963	92.0	76.2	-

Tab.3 Predictive value of each index for predicting ESRD patients

	AUC	$P$ 值	95% $C I$		敏感度	特异度	界值
	AUC	$P$ 值	下限	上限	敏感度	特异度	界值
RVD	0.765(0.621~0.908)	0.002	0.621	0.908	76.2	76.0	33.50
室间隔偏心指数	0.750(0.607~0.892)	0.004	0.607	0.892	66.7	72.0	1.035
TAPSE	0.770(0.626~0.913)	0.002	0.626	0.913	92.0	61.9	15.50
S’	0.780(0.640~0.920)	0.001	0.640	0.920	76.0	76.2	13.55
三尖瓣最大反流速度	0.707(0.543~0.870)	0.017	0.543	0.870	71.4	72.0	2.75
肺动脉收缩压	0.723(0.563~0.883)	0.010	0.563	0.883	81.0	68.0	37.50
R-RVDS	0.682(0.529~0.835)	0.035	0.529	0.835	32.0	100.0	1.75
L-RVDS	0.654(0.495~0.813)	0.074	0.495	0.813	44.0	90.5	1.75
TAPSE联合R-RVDS	0.850(0.736~0.963)	<0.001	0.736	0.963	92.0	76.2	-

Fig.3 ROC curve of the diagnostic efficacy of each parameter

References 25

[1]	Cai QJ, Mukku VK, Ahmad M. Coronary artery disease in patients with chronic kidney disease: A clinical update[J]. Curr Cardiol Rev, 2013, 9(4):331-339. doi: 10.2174/1573403x10666140214122234 pmid: 24527682
[2]	Bansal N. Evolution of cardiovascular disease during the transition to end-stage renal disease[J]. Semin Nephrol, 2017, 37(2):120-131. doi: S0270-9295(16)30132-2 pmid: 28410646
[3]	Christiadi D, Chai K, Chuah A, et al. Dynamic survival prediction of end-stage kidney disease using random survival forests for competing risk analysis[J]. Front Med (Lausanne), 2024, 11:1428073.
[4]	Ben Khadda Z, Lahmamsi H, El Karmoudi Y, et al. Chronic kidney disease of unknown etiology: A global health threat in rural agricultural communities-prevalence, suspected causes, mechanisms, and prevention strategies[J]. Pathophysiology, 2024, 31(4):761-786.
[5]	Arcentales-Vera K, Vera-Mendoza MF, Cevallos-Salas C, et al. Prevalence of cardiovascular instability during hemodialysis therapy in hospitalized patients: A systematic review and meta-analysis[J]. Sci Prog, 2024, 107(4):368504241308982.
[6]	Martensson J, Bellomo R. Does fluid management affect the occurrence of acute kidney injury?[J]. Curr Opin Anaesthesiol, 2017, 30(1):84-91. doi: 10.1097/ACO.0000000000000407 pmid: 27820741
[7]	王小亭, 刘大为, 张宏民, 等. 重症右心功能管理专家共识[J]. 中华内科杂志, 2017, 56(12):962-973.
[8]	Barozzi L, Valentino M, Santoro A, et al. Renal ultrasonography in critically ill patients[J]. Crit Care Med, 2007, 35(5):S198-S205.
[9]	Levey AS. A decade after the KDOQI CKD guidelines[J]. Am J Kidney Dis, 2012, 60(5):683-685. doi: 10.1053/j.ajkd.2012.08.019 pmid: 23067628
[10]	张宏民, 刘大为, 王小亭, 等. 感染性休克患者肾血流评分与肾血管阻力指数的关系[J]. 中华医学杂志, 2014, 94(27):2102-2105.
[11]	AbuRahma A, AbuRahma Z. Management of carotid disease in the end-stage renal disease patient[J]. Semin Vasc Surg, 2024, 37(4):427-432.
[12]	See EJ, Cullen V. Caring for Australians and New Zealanders with Kidney Impairment (CARI) Guideline Group. Commentary on the 2021 update of the KDIGO clinical practice guideline for management of blood pressure in chronic kidney disease[J]. Nephrology (Carlton), 2025, 30(1):e14414.
[13]	Bildacı YD, Korucu B, Oktan MA, et al. The relationship between body mass index changes and mortality in geriatric peritoneal dialysis patients: A case-control study[J]. BMC Nephrol, 2024, 25(1):474.
[14]	Chen X, Wang X, Honore PM, et al. Renal failure in critically ill patients, beware of applying (central venous) pressure on the kidney[J]. Ann Intensive Care, 2018, 8(1):91-97. doi: 10.1186/s13613-018-0439-x pmid: 30238174
[15]	Venet M, Malik A, Gold S, et al. Impact of right ventricular pressure overload on myocardial stiffness assessed by natural wave imaging[J]. JACC Cardiovasc Imaging, 2024:S1936-878X(24)00284-00285.
[16]	Mears J, Kaleem S, Panchamia R, et al. Leveraging the capabilities of AI: Novice neurology-trained operators performing cardiac POCUS in patients with acute brain injury[J]. Neurocrit Care, 2024, 41(2):523-532.
[17]	Li SY, Zhang Y, Shen TT, et al. Measuring of strain parameters reflects changes of right ventricular function before and after thrombolytic therapy in patients with acute pulmonary embolism[J]. Int J Cardiovasc Imaging, 2022, 38(10):2199-2208. doi: 10.1007/s10554-022-02626-8 pmid: 37726462
[18]	Jentzer JC, Tabi M, Wiley BM, et al. Doppler-derived haemodynamics performed during admission echocardiography predict in-hospital mortality in cardiac intensive care unit patients[J]. Eur Heart J Acute Cardiovasc Care, 2022, 11(8):640-650.
[19]	Darmon M, Schortgen F, Vargas F, et al. Diagnostic accuracy of doppler renal resistive index for reversibility of acute kidney injury in critically ill patients[J]. Intensive Care Med, 2011, 37(1):68-76. doi: 10.1007/s00134-010-2050-y pmid: 20862450
[20]	Trutin I, Bajic Z, Turudic D, et al. Cystatin C, renal resistance index, and kidney injury molecule-1 are potential early predictors of diabetic kidney disease in children with type 1 diabetes[J]. Front Pediatr, 2022, 10:962048.
[21]	Capotondo L, Nicolaii GA, Garosi G. The role of color doppler in acute kidney injury[J]. Arch hal Urol Androl, 2010, 82(4):275-279.
[22]	Davis S, Huber D, Murali KM, et al. Elevated renal resistive index is independently predicted by older age, but not by the presence of chronic kidney disease: A retrospective cohort study[J]. Intern Med J, 2022, 52(10):1773-1779.
[23]	Golob Janˇciˇc S, Klavž J, Filipiˇc M, et al. Comparison of different eGFR formulas to measured glomerular filtration rate using iohexol in children and adolescents with mild chronic kidney disease[J]. Eur J Pediatr, 2024, 184(1):107.
[24]	He P, Liao L. Applicability of creatinine-based glomerular filtration rate assessment equations to patients with neurogenic bladder[J]. Front Physiol, 2024, 15:1501161.
[25]	Huang CH, Tsai CJ, Su CC, et al. Accelerated risk of renal disease progression in pre-ESRD patients with proton pump inhibitors use: A nationwide population-based study[J]. BMC Nephrol, 2024, 25(1):469.