Renal resistive index in chronic kidney disease patients: Possible determinants and risk profile

Abstract

BackgroundHigh ultrasound renal resistive index (RI) predicts poor cardiorenal outcomes in chronic kidney disease (CKD) and has recently emerged as a marker of nephroprotective drugs response. Thus, having a risk profile of CKD patients with abnormal RI may be relevant for the clinicians. MethodsConsecutive patients referred to our non-dialysis CKD clinic from 01/01/2016 to 01/12/2016, were evaluated by clinical and ultrasound analysis. Inclusion criteria were age >18 years and presence of CKD defined as estimated glomerular filtration rate (eGFR)<60 mL/min/ 1.73m 2 and/or proteinuria>0.150g/24h. Renal artery stenosis, solitary kidney, acute kidney injury were the main exclusion criteria. RI value was the mean of three measures in segmental arteries in each kidney. Univariate analysis was performed to evaluate associations between continuous RI and clinical variables. Multivariate linear regression analysis, based on stepwise method with an elimination criterion of p<0.10, was used to assess the independent correlates of RI as continuous variable. ResultsWe studied 73 patients (69.9% men). Mean RI was 0.67±0.09. Frequencies of diabetes and cardiovascular disease (CVD) were 19.2% and 20.6% and median eGFR 54.1 [30.0-84.6] mL/min/1.73m 2 . From low (<0.65) to intermediate (0.65-0.70) to high (>0.70) RI categories, eGFR and haemoglobin levels were decreased while diabetes, cardiovascular disease (CVD), phosphate and smokers were higher. At univariate analysis, RI was significantly associated with age, presence of diabetes, CVD, serum phosphorus, eGFR, Urea and haemoglobin. Multi-adjusted stepwise regression analysis showed that lower eGFR levels PLOS ONE

The Value of Ketone Bodies in the Evaluation of Kidney Function in Patients with Type 2 Diabetes Mellitus

“…In the present study, it was revealed that heart rate showed association with KB concentration, while cases with high-normal levels of KBs had the lowest risk of increased PSV, and those with middlenormal levels of KBs had the lowest risk of increased RI [35]. Moreover, RI is not only a risk factor of glomerular and tubular damage and kidney disease progression but also a marker of endothelial dysfunction [36]. The results of the present study were not consistent with those reported previously, due to the following reasons.…”

Contribution of Predictive and Prognostic Biomarkers to Clinical Research on Chronic Kidney Disease

“…Evidence is also emerging for a possible role of the renal resistive index (RRI) as a dynamic predictive biomarker. RRI is a Doppler ultrasonographic index, whose increase reflects both renal and systemic vascular impairment [105]. RRI was also found to predict the onset of CV and kidney outcomes in patients with CKD or essential hypertension [106,107].…”

“…Raised RI levels above have been shown to reflect renal and systemic vascular impairment and predict CV events in hypertensive and CKD patients [105][106][107]. Medications as RAAS inhibitors and SGLT2-i reduce RRI levels over time and improve vascular damage [108,109].…”

Precision Nephrology Is a Non-Negligible State of Mind in Clinical Research: Remember the Past to Face the Future

“…To provide more insights into individual variability in drug response, the “ideal” path to follow is to find out the mechanism of damage in each individual and to find the drug that can significantly influence that mechanism, thus pursuing a targeted treatment approach. The progress obtained by “omics,” namely, novel techniques used to analyze molecular processes associated with the disease (genomics, proteomics, metabolomics, and transcriptomics) will likely allow the discovery of novel pathways of damage and consequently potential targets for therapeutic interventions [71, 91]. Genome-wide association studies identified the variants of the UMOD gene that cause overexpression of uromodulin and upregulation of the tubular transporter NKCC2.…”