title: Renal resistive index and mortality in chronic kidney disease.
abstract: Renal resistive index (RRI) measured by Doppler ultrasonography is associated with cardiovascular events and mortality in hypertensive, diabetic, and elderly patients. We studied the factors associated with high RRI (≥0.70) and its associations with mortality in chronic kidney disease patients without renal artery stenosis. We included 1962 patients with an estimated glomerular filtration rate of 15 to 59 mL/min per 1.73 m(2) who also had RRI measured (January 1, 2005, to October 2011) from an existing chronic kidney disease registry. Participants with renal artery stenosis (60%-99% or renal artery occlusion) were excluded. Multivariable logistic regression model was used to study factors associated with high RRI (≥0.70), and its association with mortality was studied using Kaplan-Meier plots and Cox proportional hazards model. Hypertension was prevalent in >90% of the patients. In the multivariable logistic regression, older age, female sex, diabetes mellitus, coronary artery disease, peripheral vascular disease, higher systolic blood pressure, and the use of β blockers were associated with higher odds of having RRI≥0.70. During a median follow-up of 2.2 years, 428 patients died. After adjusting for covariates, RRI≥0.70 was associated with increased mortality (adjusted hazard ratio, 1.29; 95% confidence interval, 1.02-1.65; P<0.05). This association was more pronounced among younger patients and those with stage 3 chronic kidney disease. Noncardiovascular/non-malignancy-related deaths were higher in those with RRI≥0.70. RRI≥0.70 is associated with higher mortality in hypertensive chronic kidney disease patients without clinically significant renal artery stenosis after accounting for other significant risk factors. Its evaluation may allow early identification of those who are at risk thereby potentially preventing or delaying adverse outcomes.
authors.affiliation: From the Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (C.T., G.T., J.V.N., S.D.N.), Department of Quantitative Health Sciences (J.D.S., S.A.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (H.L.G.), Cleveland Clinic, OH.
authors.forename: Clarisse
authors.initials: C
authors.lastname: Toledo
authors.affiliation: From the Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (C.T., G.T., J.V.N., S.D.N.), Department of Quantitative Health Sciences (J.D.S., S.A.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (H.L.G.), Cleveland Clinic, OH.
authors.forename: George
authors.initials: G
authors.lastname: Thomas
authors.affiliation: From the Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (C.T., G.T., J.V.N., S.D.N.), Department of Quantitative Health Sciences (J.D.S., S.A.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (H.L.G.), Cleveland Clinic, OH.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Schold
authors.affiliation: From the Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (C.T., G.T., J.V.N., S.D.N.), Department of Quantitative Health Sciences (J.D.S., S.A.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (H.L.G.), Cleveland Clinic, OH.
authors.forename: Susana
authors.initials: S
authors.lastname: Arrigain
authors.affiliation: From the Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (C.T., G.T., J.V.N., S.D.N.), Department of Quantitative Health Sciences (J.D.S., S.A.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (H.L.G.), Cleveland Clinic, OH.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Gornik
authors.affiliation: From the Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (C.T., G.T., J.V.N., S.D.N.), Department of Quantitative Health Sciences (J.D.S., S.A.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (H.L.G.), Cleveland Clinic, OH.
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Nally
authors.affiliation: From the Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute (C.T., G.T., J.V.N., S.D.N.), Department of Quantitative Health Sciences (J.D.S., S.A.), and Department of Cardiovascular Medicine, Heart and Vascular Institute (H.L.G.), Cleveland Clinic, OH. sankardass@gmail.com.
authors.forename: Sankar D
authors.initials: SD
authors.lastname: Navaneethan
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler; D014655:Vascular Resistance / Q000502:physiology*
keywords: cardiovascular diseases; mortality; renal artery obstruction; renal insufficiency, chronic