The predictive value of renal vascular resistance for late renal allograft loss.
The renal artery resistance index (RI), assessed by Doppler ultrasonography, was recently identified as a new risk marker for late renal allograft loss. This finding requires confirmation since RI in that study was not measured at predetermined time points and ultrasonography is operator-dependent. We investigated the predictive value of renal vascular resistance (RVR), a less operator-dependent method as assessed by mean arterial pressure divided by renal blood flow, for the prediction of recipient mortality and death-censored graft loss. RVR was compared to commonly used risk markers such as creatinine clearance (CrCl), serum creatinine (SCreat) and proteinuria (UProt) in 793 first-time cadaveric renal transplant recipients at predetermined time points after transplantation using receiver operating characteristics (ROC) and Cox survival analyses. The present study showed that RVR is a prominent risk marker for recipient mortality and death-censored graft loss. However, the predictive value of RVR for recipient mortality owed mainly to the impact of mean arterial blood pressure. In contrast, RVR constituted more than the sum of its components for death-censored graft loss, but showed less predictive value than SCreat in univariate analysis. As the assessment of RVR is expensive and time-consuming, we believe that RVR holds no clinical merit for the follow-up of renal transplant recipients.
de Vries
A P J
AP
Renal Transplant Program, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands. a.p.j.de.vries@int.umcg.nl
van Son
W J
WJ
van der Heide
J J Homan
JJ
Ploeg
R J
RJ
Navis
G
G
de Jong
P E
PE
Gans
R O B
RO
Bakker
S J L
SJ
Gansevoort
R T
RT
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001783:Blood Flow Velocity; D001794:Blood Pressure; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality / Q000473:pathology / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011507:Proteinuria; D012039:Regional Blood Flow; D012079:Renal Circulation / Q000502:physiology*; D016019:Survival Analysis; D014184:Transplantation, Homologous; D017211:Treatment Failure; D014655:Vascular Resistance / Q000502:physiology*
D000959:Antihypertensive Agents; D004232:Diuretics