Peer-reviewedCC BY-NC-SA 4.0Annals of Cardiac Anaesthesia12 Oct 2026

Prediction of Acute Kidney Injury with Venous Excess Ultrasound (VExUS) Scoring Versus Renal Resistive Index (RRI) in Patients Undergoing On-Pump Coronary Artery Bypass Grafting: A Prospective Observational Study

Shaswati Prusty¹
Manoj Kamal¹
Sadik Mohammed¹
Rakesh Kumar¹
Pradeep Kumar Bhatia¹
Geeta Singariya²
Anita Chouhan¹

¹Anaesthesiology and Critical Care, All India Institute of Medical Science, Jodhpur, Rajasthan, India
²Anaesthesiology and Critical Care, Dr. S N Medical College, Jodhpur, Rajasthan, India

Abstract

Background:: The diagnosis of acute kidney injury (AKI) using conventional markers such as serum creatinine and urine output is often delayed, prompting interest in bedside ultrasound-based predictors. This study compared renal resistive index (RRI) and venous excess ultrasound (VExUS) scoring for early prediction of AKI after on-pump coronary artery bypass grafting (CABG).

Methods:: In this prospective observational study, 180 adult patients were enrolled. RRI and VExUS assessments were performed preoperatively and within 3 hours of cardiothoracic ICU admission. AKI was diagnosed within 48 hours postoperatively using kidney disease: improving global outcomes (KDIGO) criteria. Receiver operating characteristic (ROC) curves were constructed for RRI and VExUS parameters, and diagnostic accuracy was assessed using area under ROC curve (AUROC), sensitivity, and specificity.

Results:: AKI occurred in 48 patients (26.7%). Postoperative RRI showed excellent discrimination for AKI (AUROC 0.854; cut-off ≥0.68: sensitivity 75%, specificity 86%, negative predictive value [NPV] 90.5%), outperforming preoperative RRI (AUROC 0.681). VExUS showed limited predictive performance (preoperative AUROC 0.588; postoperative AUROC 0.623). The baseline estimated glomerular filtration rate (eGFR) in the AKI group was significantly lower than in the patients who did not develop AKI [70.3 ml/min/1.73 m2 vs 79.4 ml/min/1.73 m2]. Diabetes mellitus was more common in the AKI group (62.5% vs 35.6%, P = 0.002). Postoperative urine output remained significantly lower in AKI patients on day 1 and day 2 (P < 0.001).

Conclusion:: Postoperative RRI ≥ 0.68 demonstrated the best predictive performance for early AKI in our cohort, outperforming preoperative RRI, ΔRRI or change in RRI, and VExUS scores, supporting the predominant role of intrarenal arterial hemodynamic alterations in early postoperative renal injury.

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BibTeX RIS

BibTeX

@article{prusty2026prediction,
  title = {{Prediction of Acute Kidney Injury with Venous Excess Ultrasound (VExUS) Scoring Versus Renal Resistive Index (RRI) in Patients Undergoing On-Pump Coronary Artery Bypass Grafting: A Prospective Observational Study}},
  author = {Shaswati Prusty and Manoj Kamal and Sadik Mohammed and Rakesh Kumar and Pradeep Kumar Bhatia and Geeta Singariya and Anita Chouhan},
  journal = {Annals of Cardiac Anaesthesia},
  year = {2026},
  month = oct,
  doi = {10.4103/aca.aca_26_26},
  url = {https://doi.org/10.4103/aca.aca_26_26},
  note = {CC BY-NC-SA 4.0},
}

RIS

TY  - JOUR
TI  - Prediction of Acute Kidney Injury with Venous Excess Ultrasound (VExUS) Scoring Versus Renal Resistive Index (RRI) in Patients Undergoing On-Pump Coronary Artery Bypass Grafting: A Prospective Observational Study
AU  - Shaswati Prusty
AU  - Manoj Kamal
AU  - Sadik Mohammed
AU  - Rakesh Kumar
AU  - Pradeep Kumar Bhatia
AU  - Geeta Singariya
AU  - Anita Chouhan
PY  - 2026
DA  - 2026/10/12
JO  - Annals of Cardiac Anaesthesia
DO  - 10.4103/aca.aca_26_26
UR  - https://doi.org/10.4103/aca.aca_26_26
AB  - Background:: The diagnosis of acute kidney injury (AKI) using conventional markers such as serum creatinine and urine output is often delayed, prompting interest in bedside ultrasound-based predictors. This study compared renal resistive index (RRI) and venous excess ultrasound (VExUS) scoring for early prediction of AKI after on-pump coronary artery bypass grafting (CABG).  Methods:: In this prospective observational study, 180 adult patients were enrolled. RRI and VExUS assessments were performed preoperatively and within 3 hours of cardiothoracic ICU admission. AKI was diagnosed within 48 hours postoperatively using kidney disease: improving global outcomes (KDIGO) criteria. Receiver operating characteristic (ROC) curves were constructed for RRI and VExUS parameters, and diagnostic accuracy was assessed using area under ROC curve (AUROC), sensitivity, and specificity.  Results:: AKI occurred in 48 patients (26.7%). Postoperative RRI showed excellent discrimination for AKI (AUROC 0.854; cut-off ≥0.68: sensitivity 75%, specificity 86%, negative predictive value [NPV] 90.5%), outperforming preoperative RRI (AUROC 0.681). VExUS showed limited predictive performance (preoperative AUROC 0.588; postoperative AUROC 0.623). The baseline estimated glomerular filtration rate (eGFR) in the AKI group was significantly lower than in the patients who did not develop AKI [70.3 ml/min/1.73 m2 vs 79.4 ml/min/1.73 m2]. Diabetes mellitus was more common in the AKI group (62.5% vs 35.6%, P = 0.002). Postoperative urine output remained significantly lower in AKI patients on day 1 and day 2 (P < 0.001).  Conclusion:: Postoperative RRI ≥ 0.68 demonstrated the best predictive performance for early AKI in our cohort, outperforming preoperative RRI, ΔRRI or change in RRI, and VExUS scores, supporting the predominant role of intrarenal arterial hemodynamic alterations in early postoperative renal injury.
SN  - 0971-9784
SN  - 0974-5181
ER  -

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