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NDT Advance Access originally published online on August 27, 2006
Nephrology Dialysis Transplantation 2007 22(1):163-170; doi:10.1093/ndt/gfl484
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Do ultrasound renal resistance indices reflect systemic rather than renal vascular damage in chronic kidney disease?

Gunnar H. Heine, Birgit Reichart, Christof Ulrich, Hans Köhler and Matthias Girndt

Medical Department IV, Nephrology, University Homburg, D-66421 Homburg, Germany

Correspondence and offprint requests to: Gunnar H. Heine, MD, Medical Department, Nephrology, University Homburg, D-66421 Homburg, Germany. Email: inghei{at}uniklinik-saarland.de



  Abstract

Background. In patients suffering from chronic kidney disease (CKD), ultrasound renal resistance indices predict progression of kidney disease and death. Although ultrasound resistance indices were initially considered to directly reflect intrarenal vascular resistance, they are complex composite parameters that are influenced by various vascular factors. We hypothesized that renal resistance indices reflect systemic vascular disease rather than local renal damage in patients with CKD.

Methods. In 140 patients suffering from CKD not receiving renal replacement therapy, intrarenal resistance indices were measured in interlobar arteries. For assessment of systemic atherosclerotic disease, common carotid intima-media thickness (IMT) and ankle-brachial blood pressure index were determined. Categories of risk for coronary heart diseases were defined by Framingham risk scoring.

Results. Increased renal resistance indices were associated with high Framingham risk scores and with the presence of atherosclerotic disease. In addition, ultrasound renal resistance indices progressively increased with the stage of renal function impairment, and patients suffering from diabetic nephropathy had higher resistance indices than patients suffering from other renal diseases. In a multivariate linear regression analysis, IMT, Framingham risk score, renal function, presence of diabetic nephropathy and pulse pressure independently predicted resistance indices. However, when additionally adjusting for age, IMT and Framingham risk score were no longer independent predictors of resistance indices.

Conclusions. In patients suffering from CKD, intrarenal resistance indices are independently associated with cardiovascular risk score and systemic vascular disease as well as with aetiology and stage of CKD. This may explain their strong association with both impaired renal outcome and death.

Keywords: atherosclerosis; chronic renal disease; resistive index; ultrasound


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