RENAL RESISTIVE INDEX AND ARTERIAL STIFFNESS IN KIDNEY TRANSPLANTED PATIENTS
Measurement of renal resistive index is a non-invasive method used for assessment of microvascular lesions influenced by hemodynamic factors.
The aim of our study was to introduce modern methods for assessing the arterial rigidity in patients with renal transplantation, which enable to treat and reduce it (arterial rigidity is potentially reversible), and thus reduce the risk of cardiovascular morbidity and mortality in this population.
In a cross sectional study we assessed 28 kidney transplanted patients for pulse wave velocity, renal resistive index, ambulatory arterial stiffness index and pulse pressure. The data were statistically processed in a Statistica 7.1 for Windows.
The average age of the participants was 44.07 years, 64.29% were men, average BW was 74.28 kg and BMI 25.29 kg/m2. The average graft duration was 82.28 months, and the average duration of hypertension was 142.89 months. Controlled hypertension was present in 35.71% of all hypertensive patients. Average pulse wave velocity was 6.64 ± 1.18 m/sec., ambulatory arterial stiffness index varied in the interval 0.36 ± 0.15 and the average renal resistive index of the graft’s main renal artery was 0.66 ± 0.08. Multiple regression analysis in the group of patients with graft duration below 7 years showed that both renal resistive index of the graft’s main renal artery and pulse wave velocity as dependent variables had significant and strong correlations with body weight and pulse pressure. Also, multiple regression analysis showed significant correlations between renal resistive index of graft’s main renal artery and pulse wave velocity as dependent or independent variables respectively.
Our study showed that in the group of patients with graft duration less than a 7 years renal resistive index of the graft’s main renal artery and pulse wave velocity were significantly related but this was not confirmed in the group of patients with graft duration over 7 years. Thus suggests that we are not aware of all the factors that influence this relationship and more research studies are needed in that direction involving a larger number of respondents i.e. large prospective multicenter cohort studies with sufficient long follow-up period.
1. Safar M, Plante GE, Mimran A. Arterial Stiffness, Puls Pressure, and the Kidney. AJH 2015; 28: 561
2. Safar M, London GM, Plante GE. Arterial Stiffness and the kidney function. Hypertension. 2004; 43: 163-168
3. Gosse P, Roche F, Dauphinot V, et al. Components of arterial stiffness in a population of 65 years old
subjects: PROOF study. J Hypertens. 2008; 26:1138-1146
4. Manacia G, Fagarad R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the managment of arterial
hypertension: the Task Force for the management of arterial hypertension of the European Society of
Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:2159-221
5. Heine GH, Gerhart MK, Ulrich C, Kohler H, Girndt M. Renal Doppler resistance indices are associated with
systemic artherosclerosis in kidney transplant recipients. Kidney Int 2005;68:878-85
6. Raff U, Schmidt BMW, Schwab J, et al. Renal resistive index in addition to low-grade albuminuria
complements screening for target organ damage in therapy-resistant hypertension. J Hypertens.
7. Cauwenberghs N, Kuznetsova T. Determinants and prognostic significance of the renal resistive index. Pulse
8. Birdwell KA, Jaffe G, Bian A et al. Assessment of aerterial stiffness using puls wave velocity in tacrolimus
users the firs year post kidney transplantation: a prospective cohort study. BMC Nephrology 2015; 16: 93
9. Parolini C, Noce A, Staffolani E, et al. Renal resistive index and longterm outcome in chronic nephropathies.
10. Calabia J, Torguet P, Garcia I, et al. The relationship between renal resistive index, arterial stiffness, and
atherosclerotic burden: The link between macrocirculation and mikrocirculation. The Journal of Clinical
11. Calabia J,Torguet P,Garcia M, et al. Doppler ultrasound in the measurement of pulse wave velocity:
agreement with the Complior method. Cardiovasc Ultrasound.2011;9:13
12. Li Y, Wang JG, Dolan E, et al. Ambulatory arterial stiffness index derived from 24-hour ambulatory blood
pressure monitoring. Hypertension. 2006;47:359-364
13. Dolan E, Thijs L, Li Y, et al. Ambulatory arterial stiffness index as a predictor of cardiovascular mortality in
Dublin outcome study. Hypertension. 2006;47:365-370
14. Ohta Y, Fujii K, Arima H, Tsuchihashi T, Tokumoto M, Tsuruya K, Kanai H, Iwase M, Hirakata H, Iida M.
Increased renal resistive index in atherosclerosis and diabetic nephropathy assessed by Doppler
sonography. J Hypertens. 2005 Oct;23(10):1905-11
15. Ponte B, Pruijm M, Ackermann D, Vuistiner P, Eisenberger U, Guessous I, Rousson V, Mohaupt MG, Alwan H,
Ehret G, Pechere-Bertschi A, Paccaud F, Staessen JA, Vogt B, Burnier M, Martin PY, Bochud M. Reference
values and factors associated with renal resistive index in a family-based population study. Hypertension.
16. Perpaolo Di Nicolo, Antonio Granata. Renal Resistive Index: not only kidney. Clinical and Experimental
Nephrology.2017 June, Vol 21, Issue 3, pp 359-366
17. Bude RO, Rubin JM. Relationship between the resistive index and vascular compliance and resistance.
18. Naesens M, Heylen L, Lerut E, Claes K, De Wever L, Claus F, Oyen R, Kuypers D, Evenepoel P, Bammens B,
Sprangers B, Meijers B, Pirenne J, Monbaliu D, de Jonge H, Metalidis C, De Vusser K, Vanrenterghem Y.
Intrarenal resistive index after renal transplantation. N Engl J Med. 2013 Nov 7;369(19):1797-806. doi: 1
19. Zoungas S, Kerr PG, Chadban S, et al. Arterial function after successful renal transplantation. Kidney Int.
20. Ikee R, Kobayashi S, Hemmi N, ImakiireT, Kikuchi Y, Moriya H, Suzuki S, Miura S. Correlation between the
resistive index by Dopplerultrasound and kidney function and histology. Am J Kidney Dis.2005;46:603-9
21. Hashimoto J, Ito S. Central pulse pressure and aortic stiffness determine renal hemodynamics:
pathophysiological implication for microalbuminuria in hypertension. Hypertension. 2011;58(5):839–46
22. Kocak H, Ceken K, Yavuz A, et al. Effect of renal transplantation on endothelial function in haemodialysis
patients. Nephrol Dial Transplant. 2006;21:203-7
23. Kuznetsova T, Cauwenberghs N, Knez J, Thijs L, Liu YP, Gu YM, Staessen JA. Doppler indexes of left ventricular
systolic and diastolic flow and central pulse pressure in relation to renal resistive index. Am J Hypertens.
24. Boddi M, Sacchi S, Lammel RM, et al. Age-related and vasomotor stimuli-induced changes in renal vascular
resistance detected by Doppler ultrasound. Am J Hypertens. 1996;9:461–6
25. Benetos A, Waeber B, Izzo J, et al. Influence of age, risk factors, and cardiovascular and renal disease on
arterial stiffnes: clinical aapplications. Am J Hypertens.2002;15:1101-8
26. Greenwald SE. Ageing of the conduit arteries. Journal of Pathology 2007; 211: 157- 172
27. McGrath BP, Liang YL, Kotsopoulos D, Cameron JD. Impact of physical and physiological factors on arterial
function. Clin Exp Pharmacol Physiol. 2001;28:1104-7
28. Sutton-Tyrrell K, Newman A, Simonsick EM, et al. Aortic stiffness is associated with visceral adiposity in
older adults enrolled in the study of health, aging, and body composition. Hypertension. 2001;38:429-33