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. 2020 Feb;22(2):223-230.
doi: 10.1111/jch.13819. Epub 2020 Jan 31.

Prognostic significance of the renal resistive index in the primary prevention of type II diabetes

Pascal Delsart  1 , Anne Vambergue  2   3 , Sandro Ninni  1   2 , François Machuron  4 , Bénédicte Lelievre  1 , Guillaume Ledieu  1 , Pierre Fontaine  2   3 , Emilie Merlen  2   3 , Marie Frimat  2   5 , François Glowacki  2   5 , David Montaigne  1   2   6 , Claire Mounier-Vehier  1   2
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Prognostic significance of the renal resistive index in the primary prevention of type II diabetes

Pascal Delsart et al. J Clin Hypertens (Greenwich). 2020 Feb.

Abstract

The renal resistive index has been demonstrated to predict the progression of renal disease and recurrence of major cardiac events in high-risk cardiovascular patients, in addition to other comorbidities. We aimed to assess the prognostic significance of the renal resistive index in type 2 diabetic patients for primary prevention. From 2008 to 2011, patients with type 2 diabetes underwent cardiovascular evaluation, including renal resistive index assessment by renal Doppler ultrasound. The incidence of all-cause death, cardiovascular events, dialysis requirement or a twofold increase in creatinine was recorded. Survival curves were estimated by the Kaplan-Meier method. Two hundred sixty-six patients were included; 50% of the patients were men, an HbA1C level of 8.1 ± 1.7% (65 ± 13.6 mmol/mol) and a serum creatinine level of 8 [7-9] mg/L. The mean 24-hour systolic blood pressure, 24-hour diastolic blood pressure, and 24-hour pulse pressure were 133.4 ± 16.7, 76.5 ± 9.4, and 56.9 ± 12.4 mm Hg, respectively. The median renal resistive index was 0.7 [0.6-0.7] with a threshold of 0.7 predictive of monitored events. After adjustment of the 24-hour pulse pressure, age and 24-hour heart rate, a renal resistive index ≥0.70 remained associated with all-cause death (hazard ratio: 3.23 (1.16-8.98); P = .025) and the composite endpoint of major clinical events (hazard ratio: 2.37 (1.34-4.18); P = .003). An elevated renal resistive index with a threshold of 0.7 is an independent predictor of a first cardiovascular or renal event in type 2 diabetic patients. This simple index should be implemented in the multiparametric staging of diabetes.

Keywords: diabetes mellitus; prognosis; pulse pressure; renal resistive index.

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Figures

Figure 1
Figure 1
Flowchart of the study population
Figure 2
Figure 2
Prognostic significance of the renal resistive index in the risk of death
Figure 3
Figure 3
Prognostic significance of the renal resistive index in the risk of major clinical events (major cardiovascular event or renal progression)
Figure 4
Figure 4
Prognostic significance of the renal resistive index in the risk of major cardiovascular events
Figure 5
Figure 5
Prognostic significance of the renal resistive index in the risk of renal progression
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