Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland.
Transplantation. 2013 Aug 27;96(4):406-12. doi: 10.1097/TP.0b013e318298dd46.
Increased intrarenal resistance index (RI) has been associated with decreased long-term allograft and patient survival in kidney transplant recipients. Taking into account the potential role of endothelial dysfunction, systemic inflammation, arteriosclerotic lesions, and left ventricle remodeling, we performed a cross-sectional study that aimed to evaluate extrarenal factors that may have influence on kidney graft RI in a large cohort of stable kidney transplant recipients.
One hundred seventy-four kidney transplant recipients were enrolled into the study. Mean time after transplantation was 8.4±1.8 years. Echocardiography, carotid ultrasound (intima-media thickness), pulse wave velocity, and Doppler examination of kidney graft were performed. The inflammatory markers, adhesion molecules, and plasma N-terminal prohormone of brain natriuretic peptide concentrations were also measured. Patients were divided into quartile subgroups based on RI value (Q1: RI≤0.68, Q2: RI=0.69-0.72, Q3: RI=0.73-0.76, and Q4: RI≥0.77).
The analyzed subgroups were comparable with respect to demographics (except age) and anthropometric parameters as well as comorbidities. The values of age, serum phosphate, pulse wave velocity, left ventricular mass (LVM), and LVM index (LVMI) increased in subsequent RI quartile subgroups. The strongest correlation was found between RI and age, LVM, LVMI, and plasma parathormone concentration and was negative with estimated glomerular filtration rate. In backward stepwise multivariate regression analysis, the RI variability was explained by age, LVMI, and serum phosphate concentration.
Arterial stiffness and left ventricular hypertrophy may significantly influence the intrarenal vascular resistance measured using Doppler sonography in stable kidney transplant recipients.
肾内阻力指数（RI）升高与肾移植受者长期移植物和患者存活率降低有关。考虑到内皮功能障碍、全身炎症、动脉粥样硬化病变和左心室重构的潜在作用，我们进行了一项横断面研究，旨在评估稳定肾移植受者中可能影响肾移植 RI 的肾外因素。
本研究纳入了 174 名肾移植受者。移植后平均时间为 8.4±1.8 年。进行了超声心动图、颈动脉超声（内膜-中层厚度）、脉搏波速度和肾移植多普勒检查。还测量了炎症标志物、黏附分子和血浆脑钠肽 N 末端前体浓度。根据 RI 值将患者分为四分位亚组（Q1：RI≤0.68，Q2：RI=0.69-0.72，Q3：RI=0.73-0.76，Q4：RI≥0.77）。
分析的亚组在人口统计学（除年龄外）和人体测量参数以及合并症方面具有可比性。年龄、血清磷酸盐、脉搏波速度、左心室质量（LVM）和左心室质量指数（LVMI）在随后的 RI 四分位亚组中增加。RI 与年龄、LVM、LVMI 和血浆甲状旁腺激素浓度之间存在最强的相关性，与估计肾小球滤过率呈负相关。在向后逐步多元回归分析中，RI 的变异性由年龄、LVMI 和血清磷酸盐浓度解释。
动脉僵硬和左心室肥厚可能显著影响稳定肾移植受者使用多普勒超声测量的肾内血管阻力。
