Skip to main content
SpringerLink
Log in

Resistive index predicts renal prognosis in chronic kidney disease: results of a 4-year follow-up

  • Original Article
  • Published:
Clinical and Experimental Nephrology Aims and scope Submit manuscript

Abstract

Background

While the clinical validity of Doppler ultrasonography in chronic kidney disease (CKD) is still controversial, we have shown in a 2-year follow-up study that the resistive index (RI) could estimate renal prognosis in CKD. The purpose of the present study is to determine whether RI could predict long-term renal prognosis in CKD.

Methods

We performed a 4-year follow-up study with an observational cohort of 281 CKD patients (GFR 51 ± 31 ml/min/1.73 m2, age 54 ± 17 years). The patients were examined by Doppler ultrasonography for RI [(peak-systolic velocity − end-diastolic velocity)/peak-systolic velocity] to be calculated. Glomerular filtration rate (GFR) was estimated with the revised Japanese equation. Worsening renal function was defined as a decrease in GFR of at least 20 ml/min/1.73 m2 or the need for long-term dialysis therapy until the end of the 4-year follow-up.

Results

Among the 281 CKD patients, 89 patients presented with worsening renal function during the 4-year follow-up. When we divided the patients into two groups by RI value of 0.70, Kaplan–Meier analysis showed that the event-free rates of worsening renal function at 48 months were 0.86 and 0.37 in patients with RI ≤ 0.70 and RI > 0.70, respectively (log-rank test, p < 0.001). Cox proportional-hazard analysis identified overt proteinuria (≥1.0 g/g creatinine), high RI (>0.70), low GFR (<50 ml/min/1.73 m2) and high systolic blood pressure (≥140 mmHg) as independent predictors of worsening renal function.

Conclusions

This study demonstrated that high RI as well as proteinuria, low GFR, and hypertension were independent risk factors for the progression of CKD in the 4-year follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Izumi M, Sugiura T, Nakamura H, Nagatoya K, Imai E, Hori M. Differential diagnosis of prerenal azotemia from acute tubular necrosis and prediction of recovery by Doppler ultrasound. Am J Kidney Dis. 2000;35:713–9.

    Article  CAS  PubMed  Google Scholar 

  2. Sugiura T, Nakamori A, Wada A, Fukuhara Y. Evaluation of tubulointerstitial injury by Doppler ultrasonography in glomerular diseases. Clin Nephrol. 2004;61:119–26.

    CAS  PubMed  Google Scholar 

  3. Boddi M, Cecioni I, Poggesi L, Fiorentino F, Olianti K, Berardino S, et al. Renal resistive index early detects chronic tubulointerstitial nephropathy in normo- and hypertensive patients. Am J Nephrol. 2006;26:16–21.

    Article  PubMed  Google Scholar 

  4. Ikee R, Kobayashi S, Hemmi N, Imakiire T, Kikuchi Y, Moriya H, et al. Correlation between the resistive index by Doppler ultrasound and kidney function and histology. Am J Kidney Dis. 2005;46:603–9.

    Article  PubMed  Google Scholar 

  5. Nath KA. Tubulointerstitial changes as a major determinant in the progression of renal damage. Am J Kidney Dis. 1992;20:1–17.

    CAS  PubMed  Google Scholar 

  6. Sugiura T, Wada A. Resistive index predicts renal prognosis in chronic kidney disease. Nephrol Dial Transpl. 2009;24:2780–5.

    Article  Google Scholar 

  7. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.

    Article  CAS  PubMed  Google Scholar 

  8. Eibenberger K, Schima H, Trubel W, Scherer R, Dock W, Grabenwöger F. Intrarenal Doppler ultrasonography: which vessel should be investigated? J Ultrasound Med. 1995;14:451–5.

    CAS  PubMed  Google Scholar 

  9. Watanabe S, Okura T, Kurata M, Irita J, Manabe S, Miyoshi K, et al. Valsartan reduces serum cystatin C and the renal vascular resistance in patients with essential hypertension. Clin Exp Hypertens. 2006;28:451–61.

    Article  CAS  PubMed  Google Scholar 

  10. Leoncini G, Martinoli C, Viazzi F, Ravera M, Parodi D, Ratto E, et al. Changes in renal restive index and urinary albumin excretion in hypertensive patients under long-term treatment with lisinopril and nifedipine GITS. Nephron. 2002;90:169–73.

    Article  CAS  PubMed  Google Scholar 

  11. Keith DS, Nichols GA, Gullion CM, Brown JB, Smith DH. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med. 2004;164:659–63.

    Article  PubMed  Google Scholar 

  12. Maschio G, Alberti D, Janin G, Locatelli F, Mann JF, Motolese M, et al. Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency. N Engl J Med. 1996;334:939–45.

    Article  CAS  PubMed  Google Scholar 

  13. Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345:861–9.

    Article  CAS  PubMed  Google Scholar 

  14. Iseki K, Ikemiya Y, Iseki C, Takishita S. Proteinuria and the risk of developing end-stage renal disease. Kidney Int. 2003;63:1468–74.

    Article  PubMed  Google Scholar 

  15. Yamagata K, Ishida K, Sairenchi T, Takahashi H, Ohba S, Shiigai T, et al. Risk factors for chronic kidney disease in a community-based population: a 10-year follow-up study. Kidney Int. 2007;71:159–66.

    Article  CAS  PubMed  Google Scholar 

  16. Klag MJ, Whelton PK, Randall BL, Neaton JD, Brancati FL, Ford CE, et al. Blood pressure and end-stage renal disease in men. N Engl J Med. 1996;334:13–8.

    Article  CAS  PubMed  Google Scholar 

  17. Ruggenenti P, Schieppati A, Remuzzi G. Progression, remission, regression of chronic renal diseases. Lancet. 2001;357:1601–8.

    Article  CAS  PubMed  Google Scholar 

  18. Imai E, Horio M, Yamagata K, Iseki K, Hara S, Ura N, et al. Slower decline of glomerular filtration rate in the Japanese general population: a longitudinal 10-year follow-up study. Hypertens Res. 2008;31:433–41.

    Article  PubMed  Google Scholar 

  19. Mostbeck GH, Kain R, Mallek R, Derfler K, Walter R, Havelec L, et al. Duplex Doppler sonography in renal parenchymal disease. Histopathologic correlation. J Ultrasound Med. 1991;10:189–94.

    CAS  PubMed  Google Scholar 

  20. Özbek SS, Büyükberber S, Tolunay Ö, Erden M, Aytaç S, Ölmez Ü. Image-directed color Doppler ultrasonography of kidney in systemic lupus nephritis. J Clin Ultrasound. 1995;23:17–20.

    Article  PubMed  Google Scholar 

  21. Radermacher J. Resistive index: an ideal test for renovascular disease or ischemic nephropathy? Nat Clin Pract. 2006;2:232–3.

    Article  Google Scholar 

  22. Heine GH, Gerhart MK, Ulrich C, Köhler H, Girndt M. Renal Doppler resistance indices are associated with systemic atherosclerosis in kidney transplant recipients. Kidney Int. 2005;68:878–85.

    Article  PubMed  Google Scholar 

  23. Ishimura E, Nishizawa Y, Kawagishi T, Okuno Y, Kogawa K, Fukumoto S, et al. Intrarenal hemodynamic abnormalities in diabetic nephropathy measured by duplex Doppler sonography. Kidney Int. 1997;51:1920–7.

    Article  CAS  PubMed  Google Scholar 

  24. Radermacher J, Chavan A, Bleck J, Vitzthum A, Stoess B, Gebel MJ, et al. Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis. N Engl J Med. 2001;344:410–7.

    Article  CAS  PubMed  Google Scholar 

  25. Radermacher J, Mengel M, Ellis S, Stuht S, Hiss M, Schwarz A, et al. The renal arterial resistance index and renal allograft survival. N Engl J Med. 2003;349:115–24.

    Article  PubMed  Google Scholar 

  26. Splendiani G, Parolini C, Fortunato L, Sturniolo A, Costanzi S. Resistive index in chronic nephropathies: predictive value of renal outcome. Clin Nephrol. 2002;57:45–50.

    CAS  PubMed  Google Scholar 

  27. Okura T, Kurata M, Irita J, Enomoto D, Jotoku M, Nagao T, et al. Renal resistance index is a marker of future renal dysfunction in patients with essential hypertension. J Nephrol. 2010;23:175–80.

    PubMed  Google Scholar 

  28. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003;108:2154–69.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Otemae Hospital, 1-5-34 Otemae, Chuo-ku, Osaka, Osaka, 540-0008, Japan

    Toshihiro Sugiura

  2. Department of Internal Medicine, Osaka National Hospital, Osaka, Japan

    Akira Wada

Authors
  1. Toshihiro Sugiura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akira Wada
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Toshihiro Sugiura.

About this article

Cite this article

Sugiura, T., Wada, A. Resistive index predicts renal prognosis in chronic kidney disease: results of a 4-year follow-up. Clin Exp Nephrol 15, 114–120 (2011). https://doi.org/10.1007/s10157-010-0371-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10157-010-0371-3

Keywords

Search

Navigation