Abstract
Multidisciplinary Inter-rater Reliability of Muscle Ultrasonography in Patients with AKI Requiring Continuous Kidney Replacement Therapy: TH-OR17
Journal of the American Society of Nephrology, Vol.35(10S)
10/2024
DOI: 10.1681/ASN.20246ggwcv61
Abstract
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.
Details
- Title: Subtitle
- Multidisciplinary Inter-rater Reliability of Muscle Ultrasonography in Patients with AKI Requiring Continuous Kidney Replacement Therapy: TH-OR17
- Creators
- J. Pedro Teixeira - University of New MexicoFelipe Gonzalez-Seguel - University of KentuckyVinh Tran - University of New MexicoChaitanya A. Pal - University of New MexicoZan Shareef - University of New MexicoHayley Israel - University of New MexicoArimitsu Horikawa-Strakovsky - University of KentuckyYuan Wen - University of KentuckyBenjamin R. Griffin - University of IowaJavier A. Neyra - University of Alabama at BirminghamKirby Mayer - University of Kentucky
- Resource Type
- Abstract
- Publication Details
- Journal of the American Society of Nephrology, Vol.35(10S)
- Publisher
- AMER SOC NEPHROLOGY
- DOI
- 10.1681/ASN.20246ggwcv61
- ISSN
- 1046-6673
- eISSN
- 1533-3450
- Grant note
- NIH Support - Clinical and Translational Award (CTSA) Inter-Institutional Pilot Project Award: U24TR002260
Other NIH Support - Clinical and Translational Award (CTSA) Inter-Institutional Pilot Project Award U24TR002260 (NCATS)
- Language
- English
- Date published
- 10/2024
- Academic Unit
- Internal Medicine; Nephrology
- Record Identifier
- 9984740859002771
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