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(Hypertension. 2002;39:699.)
© 2002 American Heart Association, Inc.

Scientific Contributions

Renal Resistance Index and Progression of Renal Disease

Jörg Radermacher; Sebastian Ellis; Hermann Haller

From the Department of Nephrology, Hannover Medical School, Hannover, Germany.

Correspondence to Dr Jörg Radermacher, Department of Nephrology, Medizinische Hochschule Hannover, P.O. Box 61 01 80, D-30625 Hannover, Germany. E-Mail Radermacher.Joerg{at}mh-hannover.de

The progression of renal disease depends on various clinical parameters such as hypertension and proteinuria. We recently showed that an increased renal resistance index measured by duplex ultrasound is associated with a poor prognosis in patients with renal artery stenosis. We now prospectively tested the hypothesis that a high renal resistance index (80) predicts progression of renal disease in patients without renal artery stenosis. In 162 patients newly diagnosed with renal disease, the resistance index (1-[enddiastolic velocity/maximum systolic velocity]*100) was measured in segmental arteries of both kidneys. Creatinine clearance was measured at baseline, at 3, 6, and 12 months, and then at yearly intervals thereafter (mean follow-up 3±1.4 years). The combined endpoint was a decrease of creatinine clearance by 50%, end-stage renal disease with replacement therapy, or death. Twenty-five patients (15%) had a renal resistance index value 80 at baseline. Nineteen (76%) had a decline in renal function; 16 (64%) progressed to dialysis, and 6 (24%) died. In comparison, in patients with renal resistance index values <80, 13 (9%) had a decline in renal function, only 7 (5%) became dialysis-dependent, and 2 (1%) died (P<0.001). In a multivariate regression analysis, only proteinuria and resistance index were independent predictors of declining renal function. A renal resistance index value of 80 reliably identifies patients at risk for progressive renal disease.

Key Words: ultrasonography • vascular resistance • renal disease • risk factors

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