Prognostic significance of the renal resistive index in the primary prevention of type II diabetes

Abstract

The renal resistive index has been demonstrated to predict the progression of renal disease and recurrence of major cardiac events in high‐risk cardiovascular patients, in addition to other comorbidities. We aimed to assess the prognostic significance of the renal resistive index in type 2 diabetic patients for primary prevention. From 2008 to 2011, patients with type 2 diabetes underwent cardiovascular evaluation, including renal resistive index assessment by renal Doppler ultrasound. The incidence of all‐cause death, cardiovascular events, dialysis requirement or a twofold increase in creatinine was recorded. Survival curves were estimated by the Kaplan‐Meier method. Two hundred sixty‐six patients were included; 50% of the patients were men, an HbA1C level of 8.1 ± 1.7% (65 ± 13.6 mmol/mol) and a serum creatinine level of 8 [7‐9] mg/L. The mean 24‐hour systolic blood pressure, 24‐hour diastolic blood pressure, and 24‐hour pulse pressure were 133.4 ± 16.7, 76.5 ± 9.4, and 56.9 ± 12.4 mm Hg, respectively. The median renal resistive index was 0.7 [0.6‐0.7] with a threshold of 0.7 predictive of monitored events. After adjustment of the 24‐hour pulse pressure, age and 24‐hour heart rate, a renal resistive index ≥0.70 remained associated with all‐cause death (hazard ratio: 3.23 (1.16‐8.98); P = .025) and the composite endpoint of major clinical events (hazard ratio: 2.37 (1.34‐4.18); P = .003). An elevated renal resistive index with a threshold of 0.7 is an independent predictor of a first cardiovascular or renal event in type 2 diabetic patients. This simple index should be implemented in the multiparametric staging of diabetes.

Subtle morpho-functional kidney changes in type-2 diabetes mellitus patients: A duplex ultrasound assessment

“…22 Furthermore, Delsart et al found that an elevated renal RI of more than 0.7 is an independent predictor of a first renal or cardiovascular event in T2DM patients. 23 In this study, we found no significant difference in the RL between controlled and uncontrolled DM patients. This was explained by Umanath and Lewis, who reported that kidney size and weight increase by an average 15% in DM patients and remain increased even after a decrease in kidney function.…”

“… 22 Furthermore, Delsart et al found that an elevated renal RI of more than 0.7 is an independent predictor of a first renal or cardiovascular event in T2DM patients. 23 …”

End-diastolic velocity mediates the relationship between renal resistive index and the risk of death

“…E levated renal resistive index has been identified as a powerful predictor of the risk of death in many populations, including patients with chronic kidney disease [1], diabetes mellitus [2], heart failure [3], atheromatous renovascular disease [4], and in kidney transplant recipients [5][6][7].…”

Favorable effect of renal denervation on elevated renal vascular resistance in patients with resistant hypertension and type 2 diabetes mellitus

“…Elevated renal resistive index (RRI) is a marker of subclinical renal damage and reflects an increase in renal vascular resistance ( 4 ). Furthermore, an RRI value > 0.7 is closely associated with poor renal outcomes in patients with HTN ( 5 – 7 ), CKD ( 8 ), and T2DM ( 9 , 10 ). In addition, increased RRI in patients with HTN correlates with atherosclerotic factors ( 11 ), target organ damage ( 12 ), and cardiovascular outcomes in HTN ( 7 ), including true resistant HTN (RHTN) ( 13 ).…”