Abstract
Objective: This study compared the diagnostic performance of the renal resistive index (RRI) and urinary kidney injury molecule-1 (KIM-1) for early detection of acute kidney injury (AKI) in septic intensive care unit (ICU) patients.
Design: Observational analytic study with a nested case–control design within a prospective cohort.
Setting: Intensive Care Unit of Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia, with laboratory analyses at Hasanuddin University Hospital.
Patients and participants: Forty-four septic adults (18–60 years) with normal baseline renal function were enrolled. Patients with chronic kidney disease, preexisting AKI, malignancy, or heart failure were excluded. Within 48 hours, 20 developed AKI based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria.
Interventions: None were applied. RRI was measured by Doppler ultrasonography, and urinary KIM-1 concentrations were determined by enzyme-linked immunosorbent assay (ELISA) within 24 hours of ICU admission and again 24 hours later.
Measurements and results: Both RRI and urinary KIM-1 were significantly higher in patients who developed AKI. At admission, RRI showed better diagnostic performance (area under the curve [AUC]=0.881, sensitivity=75.0%, specificity=79.2%), than KIM-1 (AUC=0.781). After 24 hours, RRI accuracy declined (AUC=0.757), while KIM-1 improved (AUC=0.904).
Conclusions: RRI reflects early functional hemodynamic changes, whereas urinary KIM-1 indicates structural tubular injury and becomes more predictive over time. Combined assessment of both biomarkers may enhance early detection of sepsis-associated AKI.
Jaka Herbiyanto, Ari Santri Palinrungi, Haizah Nurdin, Hisbullah, Faisal Muchtar, Andi Adil
