The renal arterial resistance index: a marker of renal function with an independent and incremental role in predicting heart failure progression

Abstract

AimsThe renal arterial resistance index (RRI) is a measure of renal blood flow obtained by Doppler ultrasonography, which has been demonstrated to reflect both vascular and parenchymal renal abnormalities. The aim of the study was to evaluate clinical correlates and the prognostic relevance of RRI in a group of patients affected by chronic heart failure (CHF Methods and resultsWe enrolled 250 CHF outpatients in a stable clinical condition and receiving conventional therapy. Peak systolic velocity and end-diastolic velocity of a segmental renal artery were obtained by pulsed Doppler flow. Then the RRI was calculated. Standard renal function assessment was obtained by the measurement of creatinine serum levels and the estimation of the glomerular filtration rate (GFR). During follow-up (21.4 ± 11.3 months), 41 patients experienced heart failure progression (hospitalization and/or heart transplantation and/or death due to worsening heart failure). Considered as a continuous variable, RRI was associated with events at univariate [hazard ratio (HR) 1.14; 95% confidence interval (CI) 1.09-1.19; P < 0.001] as well as at multivariate Cox regression analysis (HR 1.08; 95% CI 1.02-1.13; P = 0.004) after correction for independent predictors of the reference model. When the RRI was added to the reference model including GFR, a significant improvement of reclassification according to both category-free net reclassification improvement (NRI, 47%; 95% CI 13-80%; P = 0.006) and integrated discrimination improvement (IDI, 0.034; 95% CI 0.006-0.061; P = 0.016) was observed.

Left ventricular diastolic function in relation to the urinary proteome: a proof-of-concept study in a general population

“…In addition to HF1 and HF2, other correlates might help in screening for diastolic LV dysfunction, including albuminuria [40], circulating NTproBNP [5], and the renal resistance index [41]. However, in our participants randomly recruited from a general population the prevalence of albuminuria was too low to be useful as a screening instrument.…”

Endovascular Revascularization of a Renal Branch Occlusion in a Monorenal Patient after a 3-Branched Stent Graft Procedure of the Abdominal Aorta

“…A major concern of acute renal artery occlusion is whether an occlusion justifies an intervention since the renal parenchyma might not be salvable. Radiological findings have been proposed for predictors of renal function recovery such as the renal arterial resistance index [10]. Furthermore, reconstitution of a distal renal artery segment, which is supplied by collateral branches, and the presence of a late phase nephrogram on CTA, MRA, or DSA indicate some grade of residual perfusion [11].…”

The Renal Arterial Resistance Index Predicts Worsening Renal Function in Chronic Heart Failure Patients

“…Renal arterial Doppler was performed after echocardiographic examination by using the same echograph (Vivid 7; GE Vingmed Ultrasound, General Electric) and the same 4-MHz probe as previously described [7]. Briefly, the course of the right or left kidney segmental arteries were visualized by color flow Doppler, and pulsed Doppler was performed at the middle tract level of the best one visualized.…”

“…It has been demonstrated that it can integrate information obtained from the estimation of the glomerular filtration rate (GFR), thus improving patients' prognosis [3,4,5,6,7]. Moreover, RRI could detect early renal function abnormalities because it has been demonstrated to be associated with both vascular lesions and histological abnormalities [6].…”