Renal Resistive Index and Long-term Outcome in Chronic Nephropathies
Renal Resistive Index and Long-term Outcome in Chronic Nephropathies
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DOI：
10.1148/radiol.2523080351
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发表时间：
2009-09-01
期刊：
影响因子：
19.7
通讯作者：
Splendiani, Giorgio
中科院分区：
文献类型：
--
作者：
Parolini, Claudia;Noce, Annalisa;Splendiani, Giorgio
目的：评价肾抵抗指数（renal resistance index， RI）在慢性肾病患者长期随访中判断预后和指导治疗的临床有效性，验证常用的阈值0.70。材料与方法：自1995年以来，在肾内科中心转诊的患者中，177例首次入组，86例每年随访2-11年（平均5.93年+/- 2.92年[标准差]）。所有患者都对机构审查委员会批准的研究给予知情同意。确定初始RI与年龄、估计肾小球滤过率（eGFR）、蛋白尿、血尿、血压和活检评分之间的相关性。根据RI和eGFR的初始值是否正常，将样本分为四组，并比较肾功能衰竭的进展情况。采用初始RI（= 0.70）对样本进行分组，采用Kaplan-Meier分析获得生存曲线。结果：初始RI与最终eGFR （R = -0.4, P < 0.001）、收缩压（R = 0.39, P < 0.001）、蛋白尿（R = 0.28, P = 0.009）、年龄（R = 0.28, P = 0.007）相关。在逐步多元回归分析中，RI成为进展为肾功能衰竭的唯一独立危险因素（P < 0.001）。在初始RIs和eGFR不同的四组患者中，初始RI为0.70或更高的组预后较差，与初始eGFR无关。在使用初始RI进行Kaplan-Meier分析时，只有值为0.70或更高的组表现出肾功能的快速下降（6年内eGFR下降50%）。结论：0.70或更高的RI预示着慢性肾病患者的不良结局。
Purpose: To assess the clinical validity of renal resistive index ( RI) to determine prognosis and guide therapy over a long-term follow-up in patients with chronic nephropathies and to verify the commonly used threshold value of 0.70.Materials and Methods: Of patients referred to the nephrology center since 1995, 177 were initially enrolled and 86 were followed up for RI and renal function annually for 2-11 years (mean, 5.93 years +/- 2.92 [standard deviation]). All patients gave informed consent for the institutional review board-approved study. Correlations were determined between initial RI and age, estimated glomerular filtration rate (eGFR), proteinuria, hematuria, blood pressure, and biopsy scores. The sample was categorized in four groups on the basis of whether initial values of RI and eGFR were normal, and progression to renal failure was compared. With grouping of the sample by using initial RI (= 0.70), Kaplan-Meier analysis was used to obtain survival curves.Results: Initial RI correlated with final eGFR (R = -0.4, P < .001), systolic blood pressure (R = 0.39, P < .001), proteinuria (R = 0.28, P = .009), and age (R = 0.28, P = .007). In stepwise multiple regression analysis, RI emerged as the only independent risk factor for the progression to renal failure (P < .001). Among the four groups of patients with different initial RIs and eGFRs, the group with an initial RI of 0.70 or higher showed a worse outcome, independent of initial eGFR. In the Kaplan-Meier analysis by using initial RI, only the group with a value of 0.70 or higher showed a rapid decline of renal function (>50% decrease in eGFR in 6 years).Conclusion: An RI of 0.70 or higher is predictive of an unfavorable outcome in patients with chronic nephropathies.