TY - JOUR
T1 - Inter-rater reliability of muscle ultrasonography performed by multidisciplinary novice sonographers in the evaluation of critically ill patients with acute kidney injury requiring continuous kidney replacement therapy
AU - González-Seguel, Felipe
AU - Tran, Vinh Q.
AU - Pal, Chaitanya Anil
AU - Shareef, Zan T.
AU - Israel, Hayley P.
AU - Horikawa-Strakovsky, Arimitsu
AU - Wen, Yuan
AU - Griffin, Benjamin R.
AU - Neyra, Javier A.
AU - Teixeira, J. Pedro
AU - Mayer, Kirby P.
N1 - Publisher Copyright:
© 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2025
Y1 - 2025
N2 - 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. Muscle ultrasound (MUS) has recently gained traction for assessing muscle atrophy in the intensive care unit (ICU) but requires training to achieve reproducibility. We evaluated the inter-rater reliability of MUS in patients with AKI-CKRT performed by multidisciplinary raters including nephrologists. Two blinded independent raters used portable ultrasound to acquire images of the rectus femoris (RF). All raters were clinicians routinely caring for patients with CKRT in the ICU and were initially novices in MUS. They underwent three two-hour teleconference training sessions in MUS led by an experienced physiotherapist. Inter-rater reliability was evaluated with intraclass correlation coefficients (ICCs) [95% confidence interval] using a two-way random-effects model. We analyzed 54 MUS images (27 pairs) from nine patients 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, and echointensity were 1.7 ± 1.4 cm, 4.6 ± 2.7 cm2, and 84.0 ± 17.7 AU, respectively. Reliability was excellent for RF thickness (ICC = 0.96 [0.91–0.98], p < 0.001) and cross-sectional area (ICC = 0.92 [0.83–0.96], p < 0.001) but poor for echointensity (ICC = 0.41 [0.04–0.68], p < 0.05). These results demonstrate reliable assessment of muscle size in patients with AKI-CKRT using ultrasound performed by multidisciplinary novice sonographers trained via teleconference, suggesting that this methodology may be useful in future studies of muscle wasting in patients with AKI-CKRT.
AB - 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. Muscle ultrasound (MUS) has recently gained traction for assessing muscle atrophy in the intensive care unit (ICU) but requires training to achieve reproducibility. We evaluated the inter-rater reliability of MUS in patients with AKI-CKRT performed by multidisciplinary raters including nephrologists. Two blinded independent raters used portable ultrasound to acquire images of the rectus femoris (RF). All raters were clinicians routinely caring for patients with CKRT in the ICU and were initially novices in MUS. They underwent three two-hour teleconference training sessions in MUS led by an experienced physiotherapist. Inter-rater reliability was evaluated with intraclass correlation coefficients (ICCs) [95% confidence interval] using a two-way random-effects model. We analyzed 54 MUS images (27 pairs) from nine patients 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, and echointensity were 1.7 ± 1.4 cm, 4.6 ± 2.7 cm2, and 84.0 ± 17.7 AU, respectively. Reliability was excellent for RF thickness (ICC = 0.96 [0.91–0.98], p < 0.001) and cross-sectional area (ICC = 0.92 [0.83–0.96], p < 0.001) but poor for echointensity (ICC = 0.41 [0.04–0.68], p < 0.05). These results demonstrate reliable assessment of muscle size in patients with AKI-CKRT using ultrasound performed by multidisciplinary novice sonographers trained via teleconference, suggesting that this methodology may be useful in future studies of muscle wasting in patients with AKI-CKRT.
KW - Acute kidney injury
KW - continuous renal replacement therapy
KW - critical illness
KW - ICU-acquired weakness
KW - muscle ultrasound
KW - ultrasound training
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U2 - 10.1080/0886022X.2025.2472990
DO - 10.1080/0886022X.2025.2472990
M3 - Article
C2 - 40069097
AN - SCOPUS:105000387441
SN - 0886-022X
VL - 47
JO - Renal Failure
JF - Renal Failure
IS - 1
M1 - 2472990
ER -