Associations Between Renal Duplex Parameters and Adverse Cardiovascular Events in the Elderly: A Prospective Cohort Study

Pearce, Jeffrey D.; Craven, Timothy E.; Edwards, Matthew S.; Corriere, Matthew A.; Crutchley, Teresa A.; Fleming, Shawn H.; Hansen, Kimberley J.

doi:10.1053/j.ajkd.2009.10.044

Cited by 46 publications

(49 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Even in elderly subjects without renal insufficiency, normal RI can exceed 0.70, 3 and, thus, it remains unclear whether our results apply to very elderly subjects. 11 The relatively small number of events recorded in the present study may have limited the statistical power of our findings.…”

Section: Discussionmentioning

confidence: 76%

“…6,7 In addition, histological studies demonstrated that RI not only reflects changes in intrarenal perfusion and renovascular resistance but was increased in several pathological conditions, such as renal atherosclerosis 8 and tubulointerstitial damage. 9,10 In previous studies, the prognostic value of RI was examined only in chronic nephropathy, 6 elderly, 11 or heart failure patients 12 ; however, the results obtained were inconsistent. Thus, the status of RI as an independent cardiovascular risk marker remains to be elucidated.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Renal Resistive Index and Cardiovascular and Renal Outcomes in Essential Hypertension

Doi

Iwashima²,

Yoshihara³

et al. 2012

Hypertension

112

View full text Add to dashboard Cite

Abstract-Increased renal restive index (RI) measured using Doppler ultrasonography has been shown to correlate with the degree of renal impairment in hypertensive patients. We investigated the prognostic role of RI in cardiovascular and renal outcomes. A total of 426 essential hypertensive subjects (mean age, 63 years; 50% female) with no previous cardiovascular disease were included in this study. Renal segmental arterial RI was measured by duplex Doppler ultrasonography. During follow-up (mean, 3.1 years), 57 participants developed the primary composite end points including cardiovascular and renal outcomes. In multivariate Cox regression analysis, RI was an independent predictor of worse outcome in total subjects (hazard ratio, 1.71 for 1 SD increase), as well as in patients with estimated glomerular filtration rate (eGFR) Ͻ60 mL/min per 1.73 m 2 (hazard ratio, 2.11 for 1 SD increase; PϽ0.01, respectively). When divided into 4 groups based on the respective sex-specific median levels of RI in the eGFR Ն60 and eGFR Ͻ60 mL/min per 1.73 m 2 groups, the group with eGFR Ͻ60 and high RI (male Ն0.73, female Ն0.72) had a significantly poorer event-free survival rate ( 2 ϭ126.4; PϽ0.01), and the adjusted hazard ratio by multivariate Cox regression analysis was 9.58 (95% CI, PϽ0.01). In conclusion, impairment of renal hemodynamics evaluated by increased RI is associated with an increased risk of primary composite end points, and the combination of high RI and low eGFR is a powerful predictor of these diseases in essential hypertension. In hypertensive patients with chronic kidney disease, RI evaluation may complement predictors of cardiovascular and renal outcomes. Key Words: cardiovascular disease Ⅲ renal hemodynamics Ⅲ ultrasonography Ⅲ hypertension Ⅲ predictor I n the past few years, there has been growing attention to markers of subclinical renal damage because they provide an accurate prediction of global cardiovascular outcome.1 Renal Doppler sonography permits noninvasive assessment of intrarenal hemodynamics in addition to evaluation of anatomic information. Intrarenal arterial waveforms recorded by Doppler sonography have been widely used to evaluate renal dysfunction.2,3 Previous studies have explored the capacity of resistive index (RI) calculated from blood flow velocity in vessels to predict the progression of renal function in patients with hypertension, 4 diabetes mellitus, 5 or chronic nephropathy. 6,7 In addition, histological studies demonstrated that RI not only reflects changes in intrarenal perfusion and renovascular resistance but was increased in several pathological conditions, such as renal atherosclerosis 8 and tubulointerstitial damage. 9,10 In previous studies, the prognostic value of RI was examined only in chronic nephropathy, 6 elderly, 11 or heart failure patients 12; however, the results obtained were inconsistent. Thus, the status of RI as an independent cardiovascular risk marker remains to be elucidated. Estimated glomerular filtration rate (eGFR), which is a measure of the kidneys' ...

show abstract

Section: Discussionmentioning

confidence: 76%

mentioning

confidence: 99%

Renal Resistive Index and Cardiovascular and Renal Outcomes in Essential Hypertension

Doi

Iwashima²,

Yoshihara³

et al. 2012

Hypertension

112

View full text Add to dashboard Cite

show abstract

“…[17][18][19][20][21][22][23][24][25][26][27][28][30][31][32][33][34] To interpret this measure correctly, it is important to better understand its associated factors. Here, we identify key determinants of RRI, and our study allows the establishment of reference values based on a large sample of the general population.…”

Section: Ponte Et Al Renal Resistive Index In a Family Population Stumentioning

confidence: 99%

“…In patients with hypertension, an increased RRI has been associated with target organ damage, 17-21 albuminuria, and aortic stiffness, 22 as well as adverse cardiovascular and renal outcomes. 23,24 In patients with diabetes mellitus, RRI predicted renal function decline, albuminuria, or arterial stiffness.25-28 RRI has also been associated with renal damage at biopsy 29 and longterm progression of kidney disease in chronic renal failure. [30][31][32][33][34] Despite the interest of RRI in the recent literature, there is a lack of reference values and exploration of associated factors based on a large population-based sample.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Reference Values and Factors Associated With Renal Resistive Index in a Family-Based Population Study

et al. 2014

View full text Add to dashboard Cite

Renal Doppler was introduced in the 1980s to screen for renovascular disease and detect renal artery stenosis. 1It was also studied as a potential tool to improve the assessment of renal obstruction or transplant dysfunction. 2 The renal resistive index (RRI) obtained by the Doppler arterial waveform analysis is the most popular measure described in these pathologies. 3 It is a noninvasive and reproducible measure to investigate renal hemodynamics, 4 calculated from the peak systolic and end-diastolic velocities using the following equation: ([peak systolic velocity−end-diastolic velocity]/peak systolic velocity). RRI is based on the changes in flow velocity created by the pulsatile arterial perfusion and can be used as an estimate of renal arterial resistance. For instance, vasomotor stimuli such as sympathetic activation or fluid load can induce changes in the RRI that indirectly reflect changes in the renal vascular resistance.5 Drugs affecting arteriolar vasomotor properties, such as nitroglycerine or captopril, have also been reported to change RRI. 6,7 However, a preserved vascular compliance seems to be necessary for vascular resistance to affect RRI. 8 Hence, with increasing downstream resistance, the diastolic velocity falls relative to systolic value, and RRI increases. In contrast, in the presence of a significant (>70%) main artery stenosis, the diastolic blood flow is less affected, but a slower systole with a dampened waveform (called parvus tardus) is observed, resulting in a decreased RRI value. 9 Even with the widespread use of RRI, reference values and systematic factors influencing measurement values are not well known. Only small-sized studies have evaluated Abstract-Increased renal resistive index (RRI) has been recently associated with target organ damage and cardiovascular or renal outcomes in patients with hypertension and diabetes mellitus. However, reference values in the general population and information on familial aggregation are largely lacking. We determined the distribution of RRI, associated factors, and heritability in a population-based study. Families of European ancestry were randomly selected in 3 Swiss cities. Anthropometric parameters and cardiovascular risk factors were assessed. A renal Doppler ultrasound was performed, and RRI was measured in 3 segmental arteries of both kidneys. We used multilevel linear regression analysis to explore the factors associated with RRI, adjusting for center and family relationships. Sex-specific reference values for RRI were generated according to age. Heritability was estimated by variance components using the ASSOC program (SAGE software). Four hundred women (mean age±SD, 44.9±16.7 years) and 326 men (42.1±16.8 years) with normal renal ultrasound had mean RRI of 0.64±0.05 and 0.62±0.05, respectively (P<0.001). In multivariable analyses, RRI was positively associated with female sex, age, systolic blood pressure, and body mass index. We observed an inverse correlation with diastolic blood pressure and heart rate. Age had a nonli...

show abstract

New renal haemodynamic indices can predict worsening of renal function in acute decompensated heart failure

et al. 2020

View full text Add to dashboard Cite

Aims Worsening of renal function (WRF) is a common complication in patients with acute decompensated heart failure (ADHF). We aimed to evaluate the role of intrarenal Doppler ultrasound (IRD) in the early prediction of WRF in this patient group. Methods and results Among 90 patients (age: 57.5 ± 11.1 years; 62% male) hospitalized with ADHF, resistivity index (RI), acceleration time (AT), and pulsatility index (PI) were measured on admission and at 24 and 72 h. WRF was defined as increased serum creatinine ≥0.3 mg/dL from baseline. Adverse clinical outcomes were defined as the composite of death, use of vasopressors, and need for ultrafiltration for refractory oedema. WRF developed in 40% of patients. Mean values of renal AT, RI, and PI on admission were 59.7 ± 15, 0.717 ± 0.08, and 1.5 ± 0.48 ms, respectively. At 24 h, there was significant decrease in AT (to 56.7 ± 10 ms, P = 0.02) and renal RI (to 0.732 ± 0.07; P < 0.001); these changes were maintained up to 72 h. Renal PI showed no significant changes. Independent predictors of WRF were renal AT at 24 h and admission values of renal RI, left ventricular ejection fraction, and plasma cystatin C. Renal AT at 24 h ≥ 57.8 ms had 89% sensitivity and 70% specificity for the prediction of WRF. Independent predictors for adverse clinical outcomes were left ventricular end systolic dimension and WRF. Conclusions Among ADHF patients receiving diuretic therapy, measurement of renal AT and RI by IRD can help identify patients at increased risk for WRF.

show abstract

Associations Between Renal Duplex Parameters and Adverse Cardiovascular Events in the Elderly: A Prospective Cohort Study

Cited by 46 publications

References 35 publications

Renal Resistive Index and Cardiovascular and Renal Outcomes in Essential Hypertension

Renal Resistive Index and Cardiovascular and Renal Outcomes in Essential Hypertension

Reference Values and Factors Associated With Renal Resistive Index in a Family-Based Population Study

New renal haemodynamic indices can predict worsening of renal function in acute decompensated heart failure

Contact Info

Product

Resources

About