Clinical and Experimental Nephrology

, Volume 15, Issue 1, pp 114–120 | Cite as

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

  • Toshihiro Sugiura
  • Akira Wada
Original Article



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.


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.


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.


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.


Chronic kidney disease Doppler ultrasonography Renal prognosis Resistive index Risk factors 


  1. 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.CrossRefPubMedGoogle Scholar
  2. 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.PubMedGoogle Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. 5.
    Nath KA. Tubulointerstitial changes as a major determinant in the progression of renal damage. Am J Kidney Dis. 1992;20:1–17.PubMedGoogle Scholar
  6. 6.
    Sugiura T, Wada A. Resistive index predicts renal prognosis in chronic kidney disease. Nephrol Dial Transpl. 2009;24:2780–5.CrossRefGoogle Scholar
  7. 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.CrossRefPubMedGoogle Scholar
  8. 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.PubMedGoogle Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 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.CrossRefPubMedGoogle Scholar
  12. 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.CrossRefPubMedGoogle Scholar
  13. 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.CrossRefPubMedGoogle Scholar
  14. 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.CrossRefPubMedGoogle Scholar
  15. 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.CrossRefPubMedGoogle Scholar
  16. 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.CrossRefPubMedGoogle Scholar
  17. 17.
    Ruggenenti P, Schieppati A, Remuzzi G. Progression, remission, regression of chronic renal diseases. Lancet. 2001;357:1601–8.CrossRefPubMedGoogle Scholar
  18. 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.CrossRefPubMedGoogle Scholar
  19. 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.PubMedGoogle Scholar
  20. 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.CrossRefPubMedGoogle Scholar
  21. 21.
    Radermacher J. Resistive index: an ideal test for renovascular disease or ischemic nephropathy? Nat Clin Pract. 2006;2:232–3.CrossRefGoogle Scholar
  22. 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.CrossRefPubMedGoogle Scholar
  23. 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.CrossRefPubMedGoogle Scholar
  24. 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.CrossRefPubMedGoogle Scholar
  25. 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.CrossRefPubMedGoogle Scholar
  26. 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.PubMedGoogle Scholar
  27. 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.PubMedGoogle Scholar
  28. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2010

Authors and Affiliations

  1. 1.Department of Internal MedicineOtemae HospitalOsakaJapan
  2. 2.Department of Internal MedicineOsaka National HospitalOsakaJapan

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