Abstract
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.
| Original language | English |
|---|---|
| Article number | 2472990 |
| Journal | Renal Failure |
| Volume | 47 |
| Issue number | 1 |
| DOIs | |
| State | Published - 2025 |
Bibliographical note
Publisher Copyright:© 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
Funding
This work is supported by a Clinical and Translational Award (CTSA) Inter‐Institutional Pilot Project Award (U24TR002260) from the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS). The funder of the study had no role in study design and will have no role in the collection, management, analysis, and interpretation of data; writing of the final study report; and the decision to submit the report for publication. JAN is supported by grants from the NIH National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), including R01DK128208, U01DK12998, and P30DK079337. KPM is supported by the NIH National Institute of Arthritis and Musculoskeletal and Skin Diseases under award number K23-AR079583. JPT reports receiving consulting fees from Outset Medical and owning stock or options in Eli Lilly and Company, Novo Nordisk A/S, and Pfizer Inc. JAN reports receiving consulting fees from Baxter Healthcare and Leadiant Biosciences. The remaining authors report no financial disclosures.
| Funders | Funder number |
|---|---|
| Leadiant Biosciences | |
| National Institutes of Health (NIH) | |
| Baxter Healthcare Corporation | |
| National Center for Advancing Translational Sciences (NCATS) | |
| Pfizer | |
| National Institute of Diabetes and Digestive and Kidney Diseases | P30DK079337, U01DK12998, R01DK128208 |
| National Institute of Diabetes and Digestive and Kidney Diseases | |
| National Institute of Arthritis and Musculoskeletal and Skin Diseases | K23-AR079583 |
| National Institute of Arthritis and Musculoskeletal and Skin Diseases |
Keywords
- Acute kidney injury
- ICU-acquired weakness
- continuous renal replacement therapy
- critical illness
- muscle ultrasound
- ultrasound training
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
- Nephrology