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Halimi JM, Vernier LM, Gueguen J, Goin N, Gatault P, Sautenet B, Barbet C, Longuet H, Roumy J, Buchler M, Blacher J, de Freminville JB. End-diastolic velocity mediates the relationship between renal resistive index and the risk of death. J Hypertens 2023; 41:27-34. [PMID: 36129106 DOI: 10.1097/hjh.0000000000003293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Renal resistive index predicts the risk of death in many populations but the mechanism linking renal resistive index and death remains elusive. Renal resistive index is derived from end-diastolic velocity (EDV) and peak systolic velocity (PSV). However, the predictive value of EDV or PSV considered alone is unknown. METHODS We conducted a retrospective analysis of 2362 consecutive patients who received a kidney transplant from 1985 to 2017. EDV and PSV were measured at 3 months after transplantation, renal resistive index was calculated, and the risk of death was assessed [median follow-up: 6.25 years (0.25-29.15); total observation period: 13 201 patient-years]. RESULTS Doppler indices were available in 1721 of 2362 (78.9%) patients (exclusions: 113 who died or returned to dialysis before, 427 with no Doppler studies, 27 with renal artery stenosis, 74 missing values). Among them, 279 (16.4%) had diabetes before transplantation. Mean age was 51.5 ± 14.7, 1097 (63.7%) were male. During follow-up, 217 of 1721 (12.6%) patients died. Renal resistive index and EDV shared many determinants (notably systolic, diastolic and pulse pressure, recipient age and diabetes) unlike renal resistive index and PSV. EDV used as a binary [lowest tertile vs. higher values: (hazard ratio: 2.57 (1.96-3.36), P < 0.001)] and as a continuous (the lower EDV, the greater the risk of death) variable was significantly associated with the risk of death. This finding was confirmed in multivariable analyses. Prediction of similar magnitude was found for renal resistive index. No association was found between PSV used as a binary or a continuous variable and the risk of death. CONCLUSION Low EDV explains high renal resistive index, and the mechanism-linking renal resistive index to the risk of death is through low EDV.
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Affiliation(s)
- Jean-Michel Halimi
- Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours
- EA4245, University of Tours, Tours
- INI-CRCT, Nancy
| | - Louis-Marie Vernier
- Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours
| | - Juliette Gueguen
- Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours
| | - Nicolas Goin
- Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours
| | - Philippe Gatault
- Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours
- EA4245, University of Tours, Tours
| | - Bénédicte Sautenet
- Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours
- INI-CRCT, Nancy
- INSERM U1246 SPHERE, Université de Tours-Université de Nantes
| | - Christelle Barbet
- Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours
| | - Hélène Longuet
- Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours
| | - Jérôme Roumy
- Service d'Imagerie Médicale, Hôpital Bretonneau, CHU Tours, Tours
| | - Matthias Buchler
- Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours
- EA4245, University of Tours, Tours
| | - Jacques Blacher
- Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu
- Université Paris, Paris, France
| | - Jean-Baptiste de Freminville
- Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours
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2
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Stigler J, Tiefenthaler M. Value and limitations of sonography in kidney transplant recipients with special attention to the resistive index - An update. FRONTIERS IN NEPHROLOGY 2022; 2:997839. [PMID: 37675004 PMCID: PMC10479591 DOI: 10.3389/fneph.2022.997839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/15/2022] [Indexed: 09/08/2023]
Abstract
Kidney transplantation has become the standard treatment for end-stage renal disease. Even though the success rates are high, early and late post-transplant complications remain a major clinical problem due to the risk of graft failure. Therefore, it is of highest interest to early diagnose post-transplant complications. Ultrasound with color coded Duplex analysis plays a crucial role in imaging mechanical and vascular complications. In this article, we give an update of the visualizable complications in kidney transplant recipients and discuss the value of resistive index (RI) measurement with its limitations in allograft rejection.
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Affiliation(s)
| | - Martin Tiefenthaler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria
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3
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Gonçalves LM, Forte GC, Holz TG, Libermann LL, Figueiredo CEPD, Hochhegger B. Shear wave elastography and Doppler ultrasound in kidney transplant recipients. Radiol Bras 2022; 55:19-23. [PMID: 35210660 PMCID: PMC8864684 DOI: 10.1590/0100-3984.2020.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/23/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate the association between shear wave elastography parameters and arterial
resistance in kidney transplant recipients. Materials and Methods This was a prospective cross-sectional study involving consecutive adult kidney transplant
recipients. All patients underwent color Doppler to evaluate the resistive index (RI) and
ultrasound shear wave elastography for the quantification of renal allograft stiffness. Results We evaluated 55 patients, of whom 9 (16.4%) had an RI defined as abnormal (≥ 0.79)
and 46 (83.6%) had an RI defined as normal (< 0.79). The mean age was higher in the
abnormal RI group than in the normal RI group (68.0 ± 8.6 years vs. 42.6 ± 14.1
years; p < 0.001), as was the mean shear wave velocity (2.6 ± 0.4
m/s vs. 2.2 ± 0.4 m/s; p = 0.013). Multivariate analysis identified
two independent predictors of arterial resistance: age (OR = 1.169; 95% CI: 1.056 to 1.294;
p = 0.003) and shear wave velocity (OR = 17.1; 95% CI: 1.137 to 257.83;
p = 0.040). Conclusion We observed an association between rigidity in the cortex of the transplanted kidney, as
evaluated by shear wave elastography, and arterial resistance, as evaluated by color Doppler,
in kidney transplant recipients.
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Affiliation(s)
| | | | - Tiago Garcia Holz
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
| | | | | | - Bruno Hochhegger
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
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4
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de Freminville JB, Vernier LM, Roumy J, Patat F, Gatault P, Sautenet B, Bailly E, Chevallier E, Barbet C, Longuet H, Merieau E, Baron C, Buchler M, Halimi JM. The association between renal resistive index and premature mortality after kidney transplantation is modified by pre-transplant diabetes status: a cohort study. Nephrol Dial Transplant 2021; 35:1577-1584. [PMID: 31028403 DOI: 10.1093/ndt/gfz067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/12/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Renal resistive index (RI) predicts mortality in renal transplant recipients, but we do not know whether this is true in diabetic patients. The objective of this study was to analyse the long-term predictive value of RI for death with a functioning graft (DWFG) in renal transplant recipients with or without pre-transplant diabetes. METHODS We conducted a retrospective study in 1800 renal transplant recipients between 1985 and 2017 who were followed for up to 30 years (total observation period: 14 202 patient years). Donor and recipient characteristics at time of transplantation and at 3 months were reviewed. The long-term predictive value of RI for DWFG and the age-RI and arterial pressure-RI relationships were assessed. RESULTS A total of 284/1800 (15.7%) patients had diabetes mellitus before transplantation. RI was <0.75 in 1327/1800 patients (73.7%). High RI was associated with a higher risk of DWFG in non-diabetic patients [hazard ratio (HR) = 3.39, 95% confidence interval 2.50-4.61; P < 0.001], but not in patients with pre-transplant diabetes (HR = 1.25, 0.70-2.19; P = 0.39), even after multiple adjustments. There was no interaction between diabetes and age. In contrast, there was an interaction between RI and pulse pressure. CONCLUSION Our study indicates that RI is not a predictor of DWFG in diabetic renal transplant recipients, in contrast to non-diabetic recipients. These findings could be due to a different age-RI or pulse pressure-RI relationship.
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Affiliation(s)
| | | | - Jérome Roumy
- Imagerie Médicale, Hôpital Bretonneau, CHU Tours, Tours, France.,CIC-IT 1415, CHU Tours, Tours, France
| | - Frédéric Patat
- Imagerie Médicale, Hôpital Bretonneau, CHU Tours, Tours, France.,CIC-IT 1415, CHU Tours, Tours, France
| | - Philippe Gatault
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France.,EA4245, University of Tours, Tours, France
| | - Bénédicte Sautenet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Elodie Bailly
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Eloi Chevallier
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Christelle Barbet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Hélène Longuet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Elodie Merieau
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Christophe Baron
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France.,EA4245, University of Tours, Tours, France
| | - Matthias Buchler
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France.,EA4245, University of Tours, Tours, France
| | - Jean-Michel Halimi
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHU Tours, Tours, France.,EA4245, University of Tours, Tours, France
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5
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de Freminville JB, Vernier LM, Roumy J, Patat F, Gatault P, Sautenet B, Bailly E, Chevallier E, Barbet C, Longuet H, Merieau E, Baron C, Buchler M, Halimi JM. Impact on renal resistive index of diabetes in renal transplant donors and recipients: A retrospective analysis of 1827 kidney transplant recipients. J Clin Hypertens (Greenwich) 2019; 21:382-389. [PMID: 30767377 DOI: 10.1111/jch.13492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 01/12/2023]
Abstract
High renal resistive index (RI) is observed in diabetes and is associated with poor patient survival, but whether it is primarily due to renal vascular resistance or systemic vascular alterations is unclear. The respective impact of kidney transplant from diabetic donors or to diabetic recipients on RI would shed some light on this issue. The objective of the study was to analyze the impact of donor and recipient diabetes on RI in order to understand the respective impact of the kidney and the vascular environment. The authors conducted a retrospective study in 1827 renal transplant recipients who received a kidney between 1985 and 2017, and had Doppler measurements at 3 months after transplant. Donor and recipient characteristics at the time of transplant and at 3 months were reviewed. Both donor diabetes and recipient diabetes were associated with RI in univariate analysis, but only recipient diabetes remained significantly associated in stepwise multivariate analyses (effect estimate on RI: +0.03 ± 0.005, P < 0.001). These findings were confirmed when RI was expressed as a binary variable using a cutoff of 0.75 (OR = 2.50 [1.77, 3.54], P < 0.001). Other determinants of RI were recipient characteristics (age, sex, systolic and diastolic blood pressure, and duration of dialysis). Donor characteristics were not associated with RI. Our results suggest that high RI observed in diabetic recipients shortly after transplant is primarily due to the new vascular environment, rather than to characteristics of the transplanted kidney. Therefore, RI reflects systemic rather than intra-renal changes.
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Affiliation(s)
| | | | - Jérome Roumy
- Imagerie Médicale, Hôpital Bretonneau, CHRU Tours, Tours, France
| | - Frédéric Patat
- Imagerie Médicale, Hôpital Bretonneau, CHRU Tours, Tours, France.,CIC-IT 1415, CHRU Tours, Tours, France
| | - Philippe Gatault
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHRU Tours, Tours, France.,EA4245, François-Rabelais University, Tours, France
| | - Bénédicte Sautenet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHRU Tours, Tours, France
| | - Elodie Bailly
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHRU Tours, Tours, France
| | - Eloi Chevallier
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHRU Tours, Tours, France
| | - Christelle Barbet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHRU Tours, Tours, France
| | - Hélène Longuet
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHRU Tours, Tours, France
| | - Elodie Merieau
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHRU Tours, Tours, France
| | - Christophe Baron
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHRU Tours, Tours, France.,EA4245, François-Rabelais University, Tours, France
| | - Matthias Buchler
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHRU Tours, Tours, France
| | - Jean-Michel Halimi
- Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHRU Tours, Tours, France.,EA4245, François-Rabelais University, Tours, France
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6
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Bejic M, Déglise S, Venetz JP, Nseir G, Dubuis C, Saucy F, Berard X, Meuwly JY, Corpataux JM. Use of Intraoperative Duplex Ultrasound and Resistance Index Reduces Complications in Living Renal Donor Transplantation. Transplant Proc 2018; 50:3192-3198. [PMID: 30577184 DOI: 10.1016/j.transproceed.2018.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/05/2018] [Accepted: 08/29/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The treatment of choice in end-stage renal disease is transplantation. Hemodynamic disturbances can evoke graft loss, while early ultrasound identification of vascular problems improves outcome. The aim of this study was to identify differences in postoperative complications with and without systematic intraoperative Doppler ultrasound use. METHODS The primary outcome was the postoperative rate of complications and the secondary aim was to find a predictive resistance index cut-off value, which would show where surgical reintervention was necessary. Over a 10-year period, 108 renal transplants were performed from living donors at our institution. In group 1 (n = 67), intraoperative duplex ultrasound and intraparenchymatous resistance index measurements assessed patients, while in group 2 (n = 41), no ultrasound was performed. RESULTS There were no intergroup differences in the overall postoperative complication rate or in benefit to graft or patient survival with Doppler use. However, significantly more vascular complications (10% vs 0%, P = .02) and more acute rejections (37% vs 10%) occurred in group 2 than in group 1. Therefore, an intraoperative cut-off value of the resistance index 0.5 was proposed to justify immediate surgical revision. CONCLUSIONS This is the first report demonstrating benefits of systematic intraoperative Doppler ultrasound on postoperative complications in renal transplantation from living donors. Our results support surgical revision with a resistance index <0.5.
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Affiliation(s)
- M Bejic
- Department of Vascular Surgery, University Hospital (CHUV), Lausanne, Switzerland
| | - S Déglise
- Department of Vascular Surgery, University Hospital (CHUV), Lausanne, Switzerland.
| | - J P Venetz
- Center of Organ Transplantation, University Hospital (CHUV), Lausanne, Switzerland
| | - G Nseir
- Center of Organ Transplantation, University Hospital (CHUV), Lausanne, Switzerland
| | - C Dubuis
- Department of Vascular Surgery, University Hospital (CHUV), Lausanne, Switzerland
| | - F Saucy
- Department of Vascular Surgery, University Hospital (CHUV), Lausanne, Switzerland
| | - X Berard
- Vascular Surgery Department, Bordeaux University Hospital, Bordeaux, France
| | - J Y Meuwly
- Department of Radiology, University Hospital (CHUV), Lausanne, Switzerland
| | - J M Corpataux
- Department of Vascular Surgery, University Hospital (CHUV), Lausanne, Switzerland
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7
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Cano H, Castañeda D, Patiño N, Pérez H, Sánchez M, Lozano E, Pérez M. Resistance Index Measured by Doppler Ultrasound as a Predictor of Graft Function After Kidney Transplantation. Transplant Proc 2014; 46:2972-4. [DOI: 10.1016/j.transproceed.2014.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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8
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Morcillo E, Martín C, Rioja L, Pamplona M, Sánchez-Margallo F, Soria F. [Experimental study with Doppler ultrasound in partial chronic obstructive uropathy]. Actas Urol Esp 2012; 36:146-52. [PMID: 21955562 DOI: 10.1016/j.acuro.2011.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 07/19/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study has aimed to assess the hemodynamic parameters, Renal Resistive Index (RI), Peak Systolic Velocity (PSV), End-Diastolic Velocity (EDV) and Blood Flow of the Renal Artery (FR) by Doppler Ultrasound for diagnosis and monitoring postsurgical partial chronic obstructive uropathy. MATERIAL AND METHODS Fifty pigs were used. The experiment was divided into three phases. Phase I consisted of a duplex-Doppler evaluation of the both kidneys to determine the parameters under study. The ratio of each index is calculated as the difference between the value of study kidney and the contralateral. After, a fluoroscopic examination was performed by compressive cystography, excretory urography and retrograde ureteropyelography. Finally, a model of partial right ureteral obstruction was created. After six weeks of the obstructive model, Phase II was begun with the diagnosis of the uropathy, by means of the aforementioned diagnostic methods and the endourological treatment was completed. Phase III is a follow-up performed at 6 months of treatment using the same methods as in the previous phases. RESULTS Of the parameters studied, the EDV and its ratio showed greater sensitivity and specificity as a diagnostic marker of obstructive uropathy. In the postoperative monitoring, it was observed that the RI and the EDV returned to baseline levels, with the baseline values. CONCLUSIONS The ΔEDV and its ratio is the parameter that shows the greater efficacy for the diagnosis of chronic partial obstructive uropathy, however, it is insufficient to avoid conventional diagnostic techniques. All the parameters, mainly the EDV, have proven useful as complementary tests for monitoring after endourologic resolution of obstructive uropathy.
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9
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Mutinelli-Szymanski P, Caille A, Tranquart F, Al-Najjar A, Büchler M, Barbet C, Marlière JF, Gatault P, Réault J, Boin C, Chatelet V, Laouad I, Nivet H, Lebranchu Y, Halimi JM. Renal resistive index as a new independent risk factor for new-onset diabetes mellitus after kidney transplantation. Transpl Int 2012; 25:464-70. [PMID: 22364312 DOI: 10.1111/j.1432-2277.2012.01445.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pulse pressure and urinary albumin excretion were recently identified as risk factors of new-onset diabetes after renal transplantation (NODAT), suggesting that microvascular injury may be implicated in NODAT. However, the relationship between of microvascular injury and NODAT is unknown. In the present long-term (median follow-up: 5.7years; observation period: 4908 patient-years) retrospective study in 656 renal transplant recipients, the association between baseline renal resistance index (RI, used as a marker of widespread microvascular damage) and the incidence of NODAT was assessed. The incidence of NODAT was 11.2% and 14.6% at 5 and 10years, respectively, after transplantation. RI at 3months was a risk factor for NODAT [hazard ratio (HR) per 0.1: 2.19 (1.55-3.09), P<0.0001]. RI >0.75 (vs. 0≤0.75) was a potent a predictor of NODAT [HR: 3.29 (1.91-5.67), P<0.0001], even after adjustments [HR: 3.29 (1.50-7.24), P=0.0030] on age, weight, glucose, nephropathy, and arterial pressure. Similar results were observed when RI was measured at 1month [HR per 0.1:1.74 (1.33-2.27), P<0.0001] and 12months [HR per 0.1:1.74 (1.33-2.27), P<0.0001] after transplantation. High RI early after renal transplantation is a long-term risk factor for NODAT, and could be used to refine the individual risk of NODAT.
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