Open Access Maced J Med Sci. 2020 Jun 11; 8(B):319-323. 319 Scientifc Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2020 Jun 11; 8(B):319-323. https://doi.org/10.3889/oamjms.2020.4337 eISSN: 1857-9655 Category: B - Clinical Sciences Section: Nephrology Non-invasive Hemodynamic Monitoring of Fluid Resuscitation in Cirrhotic Patients with Acute Kidney Injury Samir El Hadidy 1 *, Ahmed Albadry 2 , Waheed Radwan 1 , Amna Metwaly 1 , Khaled Farouk 1 1 Department of Critical Care, Faculty of Medicine, Cairo University, Giza, Egypt; 2 Department of Critical Care Medicine, Theodor Bilharz Research Institute, Giza, Egypt Abstract BACKGROUND: Fluid management of patients with liver cirrhosis and acute kidney injury (AKI) is a complex problem requiring accurate assessment of the intravascular volume status and the cause of the AKI. Echocardiography used in various hemodynamic monitoring as a quick, easy, bedside, and non-invasive tool with great sensitivity. AIM: This study aims to evaluate echocardiography as a non-invasive hemodynamic monitoring tool for the assessment of volume status and cardiac function before and after volume expansion in patients with liver cirrhosis presented by AKI. PATIENTS AND METHODS: This study included 120 patients with liver cirrhosis and AKI. All patients were subjected to clinical evaluation, laboratory assessment of kidney and liver functions, and echocardiographic assessment of inferior vena cava (IVC) collapsibility index, left ventricular outfow tract velocity time integral (LVOT VTI) variability index, and cardiac output (CO). RESULTS: Comparison between responders and non-responders to volume resuscitation regarding the echocardiographic data showed that responders had signifcantly higher IVC collapsibility index, LVOT VTI variability index, and % of CO increase. IVC collapsibility index and LVOT VTI variability index showed good predictive value of fuid responsiveness. CONCLUSIONS: The use of echocardiography is a good tool for hemodynamic monitoring of fuid resuscitation in cirrhotic patients with AKI. The use of echocardiography has limited the use of central venous line only to patients with hemodynamic instability requiring vasoactive support. Edited by: Igor Spiroski Citation: Elhadidy S, Albadry A, Radwan W, Metwally A, Farouk K. Non-invasive Hemodynamic Monitoring of Fluid Resuscitation in Cirrhotic Patients with Acute Kidney Injury. Open Access Maced J Med Sci. 2020 Jun 11; 8(B):319-323. https://doi.org/10.3889/oamjms.2020.4337. Keywords: Acute Kidney Injury; Fluid Resuscitation; Liver Cirrhosis; Non-invasive Hemodynamic Monitoring *Correspondence: Samir El Hadidy. Department of Critical Care, Faculty of Medicine, Cairo University, Giza, Egypt. E-mail: Samirelhadidy81@yahoo.com Received: 22-Jan-2020 Revised: 11-May-2020 Accepted: 10-Mar-2020 Copyright: © 2020 Samir El Hadidy, Ahmed Albadry, Waheed Radwan, Amna Metwaly, Khaled Farouk Funding: This research did not receive any fnancial support Competing Interests: The authors have declared that no competing interest exists Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0) Introduction Management of cirrhotic patients admitted to intensive care unit (ICU) constitutes a special challenge due to the high morbidity and mortality rates usually encountered with this population. They have signifcant alterations in their immunological, coagulation, and hemodynamic functions which add to the diffculty of management [1], [2]. Hemodynamic changes include portal hypertension, systemic vasodilation, and hyperdynamic circulation which subsequently result in deteriorated renal and cardiac functions [3]. Acute kidney injury (AKI) is a common life-threatening complication in cirrhotic patients. It is mostly attributed to pre-renal causes, hepatorenal syndrome (HRS), or acute tubular necrosis [4], [5]. Considering the signifcant hemodynamic changes in cirrhotic patients with AKI, different types of AKI in those patients can be predicted. Among the various methods of hemodynamic monitoring, echocardiography monitoring proved to be more effcient when compared with other methods, for example, central venous pressure (CVP) monitoring [6]. However, value of this utility in the context of AKI in cirrhotic patients is rarely discussed in the literature. The present study aims to evaluate the use of echocardiography as a non-invasive hemodynamic monitoring tool for the assessment of volume status and cardiac function before and after volume expansion in patients with liver cirrhosis presented by AKI. Patients and Methods Study design and enrollment criteria The present study prospectively recruited a cohort of 40 cirrhotic patients with AKI admitted to the critical care department at Theodor Bilharz Research Institute, Cairo, Egypt. The study protocol was approved by the local ethical committee. Patients were included in the study on the basis of Child–Turcotte–Pugh classifcation for end-stage liver disease and AKI network (AKIN) classifcation for AKI [7]. Exclusion criteria included pregnancy, volume