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The Predictive Ability of the Renal Resistive Index and Its Relationship to Duplex Ultrasound Waveform Propagation in the Aorta and Renal Arteries

  • Alan P. Sawchuk
    Correspondence
    Correspondence to: Alan P. Sawchuk, MD, Professor of Surgery, Division of Vascular Surgery, Indiana University School of Medicine, 1801 N. Senate Boulevard, OPE 2, #3500, Indianapolis, IN 46202, USA
    Affiliations
    Department of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN
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  • Weichen Hong
    Affiliations
    Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN
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  • John Talamantes
    Affiliations
    Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN
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  • Md Mahfuzul Islam
    Affiliations
    Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN
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  • Xiao Luo
    Affiliations
    Department of Computer and Information Technology, Indiana University-Purdue University Indianapolis, Indianapolis, IN
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  • Huidan Yu
    Correspondence
    Correspondence to: Huidan Yu, PhD, Associate Professor, Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, 723 W. Michigan Street, SL265H, Indianapolis, IN 46202, USA
    Affiliations
    Department of Mechanical and Energy Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, IN

    Department of Vascular Surgery, Indiana University School of Medicine, Indianapolis, IN
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Published:April 22, 2022DOI:https://doi.org/10.1016/j.avsg.2022.04.019

      Background

      The objective is to investigate whether calculating the PPI (Pulse Pressure Index) and the RRI (Renal Resistive Index) using routinely collected Duplex ultrasound waveforms data obtained from the aorta and renal artery correlates and predicts renal function, and determine whether RRI is affected by the presence of a renal artery stenosis.

      Methods

      The records of 965 patients were evaluated. The RRI or pulsatility index of the aorta, renal artery, hilum, cortex, and medulla were measured with concurrent glomerular filtration rate GFR, Cr, PPI, and HR measurements, among which 75 patients had a 24-hour urine measured for CrCl, and 32 patients had aortic pulse pressure index (API) calculated from the central aortic pressure measured with applanation tonometry. The propagation of the pulsatility was evaluated by Analysis of Variance (ANOVA). The correlation coefficient (r) and the linear regression coefficient of determination R-squared (R2) were determined. The effects of a renal artery stenosis were evaluated with a paired t-Test comparing the RRI in 192 patients where only one side had a renal artery stenosis greater than 60%.

      Results

      The pulsatility indexes and RRIs progressively decreases and are statistically distinct by ANOVA from the aorta to the renal cortex (P = 7.26 × 10−125). CrCl correlates with the PPI, cortex RRI and medulla RRI with r equal to −0.34, −0.23 and −0.42 (P < 0.05). GFR correlates with the PPI, cortex RRI and medulla RRI with r equal to −0.15, −0.12, and −0.20 (P < 0.0001). Cr correlates with the PPI, cortex RRI and medulla RRI with r equal to 0.09, 0.12, and 0.14 (P < 0.005). The CrCl, GFR and Cr were not statistically correlated with the HR. On univariate and multivariate analysis, the R2 predictive value for PPI, cortex RRI and medulla RRI for CrCl, GFR and Cr were all less than 0.2 (P < 0.05). The cortex and medulla RRI were correlated with the API with r = 0.63 (P < 0.001). The R2 predictive value of the PPI for the cortex and medulla RRI was 0.41 and 0.28 (P < 0.001), respectively. On paired t-Test analysis renal artery stenosis had no effect on the RRI (P = 0.78).

      Conclusions

      The RRI is calculated based on velocity waveform propagation where pulsatility slowly decreases in a series of elastic vessels. While CrCl, GFR and Cr do correlate with the PPI, cortex RRI and medulla RRI, the R2 coefficient of determination for these correlations demonstrate that they are poor predictors of renal function. Renal artery stenosis did not have any effect on the RRI.
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      References

        • Radermacher J.
        • Ellis S.
        • Haller H.
        Renal resistance index and progression of renal disease.
        Hypertension. 2002; 39: 699-703
        • Viazzi F.
        • Leoncini G.
        • Derchi L.E.
        • et al.
        Ultrasound Doppler renal resistive index: a useful tool for the management of the hypertensive patient.
        J Hypertens. 2014; 32: 149-153
        • Di Nicolò P.
        • Granata A.
        Renal intraparenchymal resistive index: the ultrasonographic answer to many clinical questions.
        J Nephrol. 2019; 32: 527-538
        • Bigé N.
        • Lévy P.P.
        • Callard P.
        • et al.
        Renal arterial resistive index is associated with severe histological changes and poor renal outcome during chronic kidney disease.
        BMC Nephrol. 2012; 13: 1-9
        • Frauchiger B.
        • Zierler R.
        • Bergelin R.O.
        • et al.
        Prognostic significance of intrarenal resistance indices in patients with renal artery interventions: a preliminary duplex sonographic study.
        Cardiovasc Surg. 1996; 4: 324-330
        • Chen C.H.
        • Nevo E.
        • Fetics B.
        • et al.
        Estimation of central aortic pressure waveform by mathematical transformation of radial tonometry pressure. Validation of generalized transfer function.
        Circulation. 1997; 95: 1827-1836
        • Crilly M.
        • Coch C.
        • Bruce M.
        • et al.
        Repeatability of central aortic blood pressures measured non-invasively using radial artery applanation tonometry and peripheral pulse wave analysis.
        Blood Press. 2007; 16: 262-269
      1. Anova with repeated measures using SPSS statistics. One-way ANOVA with repeated measures in SPSS Statistics - step-by-step procedure including assumptions. (n.d.).
        (Retrieved from:)
        • D’Souza D.
        • Jones J.
        • et al.
        Renal artery stenosis. Reference article..
        Radiopedia.org. 2008;
        • Granata A.
        • Fiorini F.
        • Andrulli S.
        • et al.
        Doppler ultrasound and renal artery stenosis: an overview.
        J Ultrasound. 2009; 12: 133-143
        • Elkenani H.
        • Al-Bahkali E.
        • Souli M.
        Numerical investigation of pulse wave propagation in arteries using fluid structure interaction capabilities.
        Comput Math Methods Med. 2017; 2017: 4198095
        • Swinscow D.V.
        • Campbell M.J.
        Statistics at Square One. Ninth Editio. University of Southampton BMJ Publishing Group, 1997
        • Tedesco M.
        • Natale F.
        • Mocerino R.
        • et al.
        Renal resistive index and cardiovascular organ damage in a large population of hypertensive patients.
        J Hum Hypertens. 2007; 21: 291-296
        • Mostbeck G.
        • Kain R.
        • Mallek R.
        • et al.
        Duplex Doppler sonography in renal parenchymal disease. Histopathologic correlation.
        J Ultrasound Med. 1991; 10: 189-194
        • Raff U.
        • Schwarz T.K.
        • Schmidt B.M.
        • et al.
        Renal resistive index—a valid tool to assess renal endothelial function in humans?.
        Nephrol Dial Transplant. 2010; 25: 1869-1874
        • Kim S.
        • Kim W.
        • Choi B.
        • et al.
        Duplex Doppler US in patients with medical renal disease: resistive index vs serum creatinine level.
        Clin Radiol. 1992; 45: 85-87
        • Brardi S.
        • Cevenini G.
        Low systolic blood pressure values, renal resistive index measurement and glomerular filtration rate in a non-dialysis dependent chronic kidney disease population.
        Archivio Italiano di Urologia e Andrologia. 2018; 90: 288-292
        • Petersen L.
        • Petersen J.
        • Ladefoged S.
        • et al.
        The pulsatility index and the resistive index in renal arteries in patients with hypertension and chronic renal failure.
        Nephrol Dial Transplant. 1995; 10: 2060-2064
        • Ikee R.
        • Kobayashi S.
        • Hemmi N.
        • et al.
        Correlation between the resistive index by Doppler ultrasound and kidney function and histology.
        Am J kidney Dis. 2005; 46: 603-609
        • Hafeez A.R.
        • Idrees M.K.
        • Akhtar S.F.
        Transplantation. Accuracy of GFR estimation formula in determination of glomerular filtration rate in kidney donors: comparison with 24 h urine creatinine clearance.
        Saudi J Kidney Dis. 2016; 27: 320-325
        • Afsar B.
        • Elsurer R.
        Comparison of renal resistive index among patients with Type 2 diabetes with different levels of creatinine clearance and urinary albumin excretion.
        Diabet Med. 2012; 29: 1043-1046
        • Xiao W.
        • Wen Y.
        • Ye P.
        • et al.
        Noninvasive central pulse pressure is an independent determinant of renal function.
        J Clin Hypertens. 2020; 22: 234-242
        • Lee M.-K.
        • Hsu P.-C.
        • Chu C.-Y.
        • et al.
        Significant correlation between brachial pulse pressure index and renal resistive index.
        Acta Cardiologica Sinica. 2015; 31: 98-105
        • Tang K.S.
        • Medeiros E.D.
        • Shah A.D.
        Wide pulse pressure: a clinical review.
        J Clin Hypertens. 2020; 22: 1960-1967
        • Niederstadt C.
        • Steinhoff J.
        Die Nieren im Alter.
        Z Gerontol Geriatr. 1997; 30: 200-207
        • Li J-c
        • Yuan Y.
        • Qin W.
        • et al.
        Evaluation of the tardus-parvus pattern in patients with atherosclerotic and nonatherosclerotic renal artery stenosis.
        J Ultrasound Med. 2007; 26: 419-426
        • Mostbeck G.H.
        • Gössinger H.D.
        • Mallek R.
        • et al.
        Effect of heart rate on Doppler measurements of resistive index in renal arteries.
        Radiology. 1990; 175: 511-513
        • Liu N.T.
        • Kramer G.C.
        • Khan M.N.
        • et al.
        Blood pressure and heart rate from the arterial blood pressure waveform can reliably estimate cardiac output in a conscious sheep model of multiple hemorrhages and resuscitation using computer machine learning approaches.
        J Trauma Acute Care Surg. 2015; 79: S85-S92
        • Sung Chang
        • Han Bongsoo
        • Kim Seung Hyup
        Evaluation of the factors influencing the renal arterial Doppler waveform: a simulation study using an electrical circuit model.
        Ultrasonography. 2015; 35: 69-77