Reliability of bedside ultrasound for measurement of quadriceps muscle thickness in critically ill patients with acute kidney injury

• Published in: Clinical nutrition (Edinburgh, Scotland) Scotland), 2017-12, Vol.36 (6), p.1710-1715
• Main Authors: Sabatino, Alice, Regolisti, Giuseppe, Bozzoli, Laura, Fani, Filippo, Antoniotti, Riccardo, Maggiore, Umberto, Fiaccadori, Enrico
• Format: Article
• Language: English
• Subjects: Acute kidney injury; Acute Kidney Injury - complications; Adolescent; Adult; Body Composition; Body Mass Index; Critical Illness; Cross-Sectional Studies; Female; Gastroenterology and Hepatology; Humans; Lean body mass; Male; Nutritional status; Quadriceps Muscle - diagnostic imaging; Renal replacement therapy; Reproducibility of Results; Ultrasonography; Ultrasound; Young Adult
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2016.09.029

Summary Main problem In patients with Acute Kidney Injury there is a lack of nutritional variables that can assess nutritional status, more specifically lean body mass (LBM) and skeletal muscle mass, at the individual level. In this clinical setting, ultrasound (US)) of the quadriceps femoris could represent a widely available, non-invasive, affordable, and reliable tool to evaluate skeletal muscle. Methods We performed a cross-sectional observational study in adult critically ill patients with KDIGO stage 3 AKI on dialysis. Quadriceps rectus femoris and vastus intermedius thickness were measured by two assessors. Intra- and interobserver reliability was evaluated using the intraclass correlation coefficient (ICC). The same US measures were obtained before and after dialysis. Results We enrolled 34 patients, 22 (65%) were male and the mean APACHE II score was 22.7 (±5.6). In the intraobserver reliability study, assessor 1 performed 288 paired measurements and assessor 2 performed 430 paired measurements in 34 patients, with an ICC equal to 0.99 and 1.00, respectively. There were 238 paired measurements (34 patients) in the interobserver reliability study, with an ICC = 0.92. No difference was found in the measurements obtained before and after dialysis (11.5 (4.2) vs 11.4 (4.1) mm, P = 0.2498), independently from acute body weight changes due to fluid removal. Conclusion In patients with AKI, US of quadriceps femoris could represent a simple, accurate, and non-invasive method to evaluate quantitative changes in skeletal muscle.