Feasibility and reproducibility of renal flow reserve with combined pressure and flow velocity measurements

Brussel, Peter M. van; Lavieren, Martijn A. van; Wijntjens, Gilbert; Collard, Didier; Lienden, Krijn P. van; Reekers, Jim A.; Vogt, Liffert; Piek, Jan J.; Winter, Robbert J. de; Born, Bert‐Jan H. van den

doi:10.4244/eij-d-18-01101

Cited by 4 publications

(4 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our own results showed that a second dosage of dopamine leads to the same reproducible maximal flow velocity even when the washout of the first dosage is not complete. 18 In line, repeated intrarenal administration of dopamine resulted in a similar decrease in Pglom. Comparable with findings in animal models and human studies, we found that increases in Pglom were associated with an increase in perfusion pressure, presence of diabetes, and BMI.…”

Section: Fð0þmentioning

confidence: 75%

“…The HERA study is an observational cohort study performed at the Amsterdam University Medical Centers (location Academic Medical Center), for which the methods have been described in detail elsewhere. 18 In brief, additional intrarenal pressure and flow velocity measurements were performed in patients with a clinical indication for coronary or renal angiography. For inclusion, patients had to be between 18 and 75 years old and in a clinically stable condition.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…16,17 Recently, we have shown that measurement of intrarenal hyperemic flow velocity during dopamine-induced hyperemia is feasible and reproducible. 18 The renal circulation consists of afferent and efferent arteriolar systems, which can more or less independently influence GFR. Therefore, it is important to separate afferent from efferent vessels in order to determine their effect on glomerular filtration and kidney oxygenation.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Estimation of Intraglomerular Pressure Using Invasive Renal Arterial Pressure and Flow Velocity Measurements in Humans

Collard

Brussel

Velde

et al. 2020

JASN

Self Cite

View full text Add to dashboard Cite

BackgroundGlomerular hyperfiltration resulting from an elevated intraglomerular pressure (Pglom) is an important cause of CKD, but there is no feasible method to directly assess Pglom in humans. We developed a model to estimate Pglom in patients from combined renal arterial pressure and flow measurements.MethodsWe performed hemodynamic measurements in 34 patients undergoing renal or cardiac angiography under baseline conditions and during hyperemia induced by intrarenal dopamine infusion (30 μg/kg). For each participant during baseline and hyperemia, we fitted an adapted three-element Windkessel model that consisted of characteristic impedance, compliance, afferent resistance, and Pglom.ResultsWe successfully analyzed data from 28 (82%) patients. Median age was 58 years (IQR, 52–65), median eGFR was 95 ml/min per 1.73 m2 (IQR, 74–100) using the CKD-EPI formula, 30% had microalbuminuria, and 32% had diabetes. The model showed a mean Pglom of 48.0 mm Hg (SD=10.1) at baseline. Under hyperemia, flow increased by 88% (95% CI, 68% to 111%). This resulted in a 165% (95% CI, 79% to 294%) increase in afferent compliance and a 13.1-mm Hg (95% CI, 10.0 to 16.3) decrease in Pglom. In multiple linear regression analysis, diabetes (coefficient, 10.1; 95% CI, 5.1 to 15.1), BMI (0.99 per kg/m2; 95% CI, 0.38 to 1.59), and renal perfusion pressure (0.42 per mm Hg; 95% CI, 0.25 to 0.59) were significantly positively associated with baseline Pglom.ConclusionsWe constructed a model on the basis of proximal renal arterial pressure and flow velocity measurements that provides an overall estimate of glomerular pressure and afferent and efferent resistance in humans. The model provides a novel research technique to evaluate the hemodynamics of CKD on the basis of direct pressure and flow measurements.Clinical Trial registry name and registration numberFunctional HEmodynamics in patients with and without Renal Artery stenosis (HERA), NL40795.018.12 at the Dutch national trial registry (toetsingonline.nl).

show abstract

Section: Fð0þmentioning

confidence: 75%

Section: Study Design and Participantsmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Estimation of Intraglomerular Pressure Using Invasive Renal Arterial Pressure and Flow Velocity Measurements in Humans

Collard

Brussel

Velde

et al. 2020

JASN

Self Cite

View full text Add to dashboard Cite

show abstract

“…At present, the assessment of effectiveness of ablation devices primarily relies on animal models, human cadaver studies and renal norepinephrine levels. Similar to physiological assessment of flow and flow reserve in the coronary arteries, renal flow reserve may become useful in this setting [ 2 ]. Although this issue still has not been solved, recent randomised sham-controlled trials (DENERHTN, SPYRAL HTN-ON MED, SPYRAL HTN-OFF MED, RADIANCE HTN SOLO) have sparked renewed interest because they demonstrated clinically significant reduction of ambulatory blood pressure in comparison with control groups [ 3 ].…”

Section: So Does Rdn Have a Future Role To Play In The Treatment Of O...mentioning

confidence: 99%

Renal denervation revisited; should we pay attention?

Winter

2022

Neth Heart J

View full text Add to dashboard Cite

In this issue of the journal, L. Feyz and colleagues present the results of a small, randomised study investigating the safety and efficacy of renal denervation (RDN) in patients with heart failure and reduced ejection fraction [1]. Primary safety endpoint was the combination of cardiovascular death, rehospitalisation for heart failure, and acute kidney injury at 6 months. Efficacy was defined as the change in iodine-123 labelled meta-iodobenzylguanidine ( 123 I-MIBG) heart-to-mediastinum ratio at 6 months. The authors demonstrate that RDN with the Vessix V2 Renal Denervation System (Boston Scientific, Natick, MA, USA) was safe, but the primary efficacy endpoint was not different when comparing the RDN treated patients with the patients treated with optimal medical therapy.The study was small, only 50 patients, less than the anticipated 71 patients. However, collecting these data has been the result of a major endeavour. The study group screened 343 eligible patients over a period of 4 years. Patients randomised to RDN underwent the invasive procedure and all patients underwent MIBG scanning, with subsequent meticulous follow-up for 6 months to assess outcomes. It is important that neutral or negative studies, albeit small, are published for readers to appreciate the outcomes as well as to prevent scientific information to become inadvertently skewed to positive results. R. J. de Winter ( )

show abstract

The spectrum and systemic associations of microvascular dysfunction in the heart and other organs

et al. 2022

View full text Add to dashboard Cite

Feasibility and reproducibility of renal flow reserve with combined pressure and flow velocity measurements

Cited by 4 publications

References 5 publications

Estimation of Intraglomerular Pressure Using Invasive Renal Arterial Pressure and Flow Velocity Measurements in Humans

Estimation of Intraglomerular Pressure Using Invasive Renal Arterial Pressure and Flow Velocity Measurements in Humans

Renal denervation revisited; should we pay attention?

The spectrum and systemic associations of microvascular dysfunction in the heart and other organs

Contact Info

Product

Resources

About