Renal resistive index and aortic knob width relationship as a predictor of renal prognosis in essential hypertension

Abstract

The scientific studies that have been conducted so far highlight that renal resistive index (RI) and aortic knob width (AKW) indicate poor prognosis regarding renal and cardiovascular mortality. But the existence of a direct relationship RI and AKW is unclear. This study aims investigating the relationship between RI and the measured AKW in chest radiography of the patients with hypertensive nephropathy who do not require renal replacement therapy.This prospective study included 268 consecutive patients with essential hypertension. Patients were divided into 2 groups as RI ≥0.7 and RI <0.7. The ROC curve, sensitivity, and specificity ratios were evaluated to determine which AKW value is the best predictive one for the RI ≥0.7.The cutoff point of AKW was evaluated as ≥36 for the cases with RI ≥0.7: sensitivity was 71.22%; specificity was 71.32%; the positive predictive value (PPV) was 72.79; the negative predictive value (NPV) was 69.70, and the accuracy was 71.27. Area under the ROC curve ± standard error (AUC ± SE) = 0.729 ± 0.031 (P < .001).AKW can provide important predictive information about the subclinical renal dysfunction in hypertensive patients with RI ≥0.7. Moreover; AKW is a predictive factor for both the diagnostic and prognostic evaluation of renal pathologies.

Renal Resistive Index as An Indicator of Atherosclerotic Changes and Renal Damage in Hypertension and Its Role in Therapeutic Intervention

“…Moreover, the RRI in our hypertensive patients showed highly significant correlation with both AKW and carotid IMT parameters. Sevencan and Ozkan (1) observed a close relationship between AKW and RRI with an AKW value of ≥ 36 in hypertensive patients having high RRI (≥ 0.7). In addition, Doi et al (18) found significant correlation between RRI and carotid IMT similar to our results and RRI was increasing in a significant manner with increasing target organ damage.…”

“…As the kidney is one of these target organs, detection of renal indicators as increased albumin in urine or diminished GFR were suggested to be checked early in these cases as primary parameters for evaluation of their renal and further cardiovascular risks. Currently, renal resistive index was suggested as a noninvasive evaluation method for hypertensive renal and cardiovascular pathological changes (1) .…”

“…According to Madubueze and Ugwa (14) "this increase in mean renal RI value is an early sign seen in adults with essential hypertension as a result of hypertension-induced myointimal hyperplasia of the renal arterioles". A normal cutoff value of RRI was considered as 0.7 by Sevencan and Ozkan (1) and some other studies and any subjects with higher values are prone to more prevalence of hypertensive end-organ damage and rapid occurrence of renal deterioration (15,18) .…”

“…In Egypt, prevalence of hypertension was estimated to be 26.3% among adult subjects and increases with age, to reach around 50% of Egyptians over 60 years. It is considered a major risk factor for occurrence of cardio-vascular events, in addition to subsequent renal and cerebro-vascular complications (1,2) .…”

Aortic knob width is associated with non-dipping blood pressure pattern

“…Sevencan et al showed that when combined with renal resistive index, AKW could be a diagnostic and prognostic predictor of renal pathologies in individuals with essential hypertension [18].…”