Kidney Res Clin Pract.  2013 Dec;32(4):158-163.

Resistive index as a predictor of acute kidney injury caused by an angiotensin converting enzyme inhibitor or angiotensin II receptor blocker in chronic kidney disease patients

• Kim ES
• Kim HJ
• Kim YJ
• Lee SM
• Lee HJ
• Cho DS
• Son YK
• Kim SE
• Kim KH
• An WS

Abstract

BACKGROUND
Angiotensin converting enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) may induce acutekidney injury (AKI).The aim of this study was to evaluate the role of the resistive index (RI), which reflects renal artery resistance on renal duplex ultrasonography, as a predictor of AKI in chronic kidney disease (CKD) patients who are prescribed an ACE inhibitor or ARB.
METHODS
We screened 105 CKD patients evaluated with renal duplex ultrasonography from 2008 to 2012. We excluded patients not treated with ACE inhibitor or ARB and diagnosed with renal artery stenosis. Finally, we retrospectively analyzed the medical records of 54 patients. AKI was defined as increased serum creatinine by >30% compared with baseline after starting ACE inhibitor or ARB treatment.
RESULTS
The mean age of the patients was 60.5+/-13.0 years, serum creatinine level was 1.85+/-0.85 mg/dL and 22.2% of the patients had AKI after the use of an ACE inhibitor or ARB. The RI (P=0.006) and the percentages of patients with diabetes (P=0.008)and using diuretics (P=0.046) were higher in the AKI group.The area under the receiver operating characteristics curve for the prediction of AKI was 0.736 (95% confidence interval=0.587-0.885, P=0.013),and RI> or =0.80 predicted AKI with 83.3% sensitivity and 61.9% specificity. In the multivariate analysis, RI> or =0.80 was an independent prognostic factor [Exp (B)=8.03, 95% confidence interval=1.14-56.74, P=0.037] for AKI.
CONCLUSION
RI> or =0.80 on the renal duplex ultrasonography may be a helpful predictor for AKI in CKD patients who are prescribed an ACE inhibitor or ARB.

Keyword

Acutekidneyinjury; Angiotensin converting enzyme inhibitors; Angiotensin II receptor blockers; Diuretics; Duplex Doppler ultrasonography

MeSH Terms

Acute Kidney Injury*
Angiotensin II*
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Angiotensins*
Creatinine
Diuretics
Humans
Medical Records
Multivariate Analysis
Peptidyl-Dipeptidase A*
Receptors, Angiotensin*
Renal Artery
Renal Artery Obstruction
Renal Insufficiency, Chronic*
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Ultrasonography
Ultrasonography, Doppler, Duplex
Angiotensin II
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Angiotensins
Creatinine
Diuretics
Peptidyl-Dipeptidase A
Receptors, Angiotensin