Kidney Week

Abstract: TH-OR17

Multidisciplinary Inter-rater Reliability of Muscle Ultrasonography in Patients with AKI Requiring Continuous Kidney Replacement Therapy

Session Information

• AKI: New Frontiers in Prognostication and Management
  October 24, 2024 | Location: Room 6C, Convention Center
  Abstract Time: 05:40 PM - 05:50 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Teixeira, J. Pedro, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States

J. Pedro Teixeira, MD, FASN

• Gonzalez-Seguel, Felipe, University of Kentucky College of Health Sciences, Lexington, Kentucky, United States

Felipe Gonzalez-Seguel, MSc

• Tran, Vinh, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States

Vinh Tran, PhD

• Pal, Chaitanya A., University of New Mexico School of Medicine, Albuquerque, New Mexico, United States

Chaitanya A. Pal, MD

• Shareef, Zan, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States

Zan Shareef, MD

• Israel, Hayley, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States

Hayley Israel, MD, MHS

• Horikawa-Strakovsky, Arimitsu, University of Kentucky Center for Muscle Biology, Lexington, Kentucky, United States

Arimitsu Horikawa-Strakovsky

• Wen, Yuan, University of Kentucky Institute for Biomedical Informatics, Lexington, Kentucky, United States

Yuan Wen, MD, PhD

• Griffin, Benjamin R., University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States

Benjamin R. Griffin, MD

• Neyra, Javier A., The University of Alabama at Birmingham Department of Medicine, Birmingham, Alabama, United States

Javier A. Neyra, MD, MS, FASN

• Mayer, Kirby, University of Kentucky College of Health Sciences, Lexington, Kentucky, United States

Kirby Mayer, PhD

Background

Early diagnosis of muscle wasting in critically ill patients with acute kidney injury requiring continuous kidney replacement therapy (AKI-CKRT) may improve outcomes via timely rehabilitation and nutrition. Musculoskeletal ultrasound (MSK-US) has gained traction for assessing muscle atrophy in the intensive care unit (ICU) but requires training to achieve reproducibility. We evaluated the inter-rater reliability (IRR) of MSK-US in patients with AKI-CKRT carried out by a multidisciplinary group of providers including nephrologists.

Methods

Two blinded and independent raters used portable US devices to acquire images of rectus femoris (RF) at baseline (within 48h of CKRT initiation), day 3, day 7, ICU discharge, hospital discharge, and 1–3 months after discharge. All raters were clinicians or trainees routinely caring for patients with AKI-CKRT in the ICU and were initially novices in MSK-US. They underwent three 2-h teleconference training sessions in MSK-US led by an experienced physiotherapist. IRR was evaluated with intraclass correlation coefficient (ICC) [95% confidence interval] using a 2-way random-effects model.

Results

Raters acquired 54 (27 per rater) US images from 9 subjects at baseline (n=16), day 3 (n=6), day 7 (n=8), ICU discharge (n=10), hospital discharge (n=10), and 1–3 months after discharge (n=4). The mean (± standard deviation) values of RF thickness, cross-sectional area (CSA), and echointensity (EI) were 1.7 ±1.4 cm, 4.6 ±2.7 cm², and 84.0 ±17.7 AU, respectively. IRR was excellent for muscle thickness (ICC = 0.96 [0.91–0.98], p<0.001) and CSA (ICC = 0.92 [0.83–0.96], p<0.001) and moderate for EI (ICC = 0.41 [0.04–0.68], p<0.05). The absolute agreement between raters is shown by Bland-Altman plots (Fig 1).

Conclusion

Our results demonstrate reliable assessment of muscle quality and especially size in ICU patients with AKI-CKRT using US performed by multidisciplinary clinicians and trainees including nephrologists. This study suggests MSK-US may be a useful tool to diagose critical illness myopathy in the AKI-CKRT population.

Funding

• Other NIH Support