Evaluation of volume status by ultrasonographic methods in patients with acute kidney injury in the emergency department and its importance in the clinical process

Recent studies have emphasized that venous hypertension and excessive fluid therapy negatively affect kidney functions. Based on this information, the aim of our study is to compare the bedside lung, portal vein, inferior vena cava ultrasound measurements and clinical volume status indicators of patients with AKI detected in the emergency department according to KDIGO criteria and to investigate their effects on treatment management. The study is single-center, prospective and observational. Eskişehir Osmangazi University Clinical Research Ethics Committee approval was obtained. Treatments (IV hydration, diuretic, hemodialysis, and ultrafiltration), mortality, and clinical conditions on time of disposition 1st and 3rd months were compared in patients aged 18 and over who were hospitalized with AKI according to KDIGO criteria. A total of 100 patients were included in the study. Coronary artery disease, congestive heart failure and KDIGO "Stage 1" injury were more common in hypervolemic patients (p=0.037, p<0.001 and p=0.020, respectively). Twenty-one (87.5%) patients with B profile, 21 (87.5%) with VCI collapsibility index ≤50%, and 16 (66.7%) patients with biphasic portal vein flow pattern were hypervolemic. Patients with clinically hypervolemics, B profile on ultrasound and biphasic portal vein flow pattern had a higher mortality (p=0.008, p=0.005 and p=0.026, respectively). In the hypervolemic group, HD (UF+) was applied in the emergency department statistically significantly more than in the non-hypervolemic patients (p=0.011). As the treatments were compared, it was seen that clinical findings and lung US findings were decisive, and portal vein US findings could be used in the detection of hypervolemia and in the planning of fluid removal treatment.