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Determinants of intrarenal Doppler indices in stable renal allografts
1Department of Internal Medicine IV, University Hospital Freiburg, Germany.
Insights
Intrarenal Doppler indices like resistive index (RI) and pulsatility index (PI) in renal transplant recipients are influenced by recipient age and pulse pressure, not graft function. Monitoring requires intraindividual comparison for detecting changes.
Area of Science:
- Nephrology
- Radiology
- Vascular Ultrasound
Background:
- Color Doppler sonography is used for renal transplant graft monitoring.
- Factors influencing intrarenal Doppler indices (RI, PI) for transplant dysfunction are not well understood.
Purpose of the Study:
- To investigate determinants of resistive index (RI) and pulsatility index (PI) in stable renal allografts.
- To identify factors impacting Doppler indices as indicators of transplant dysfunction.
Main Methods:
- Studied 110 patients with stable renal allografts.
- Utilized multivariate regression analysis to assess correlations between Doppler indices (RI, PI) and various patient/donor factors.
Main Results:
- RI and PI correlated significantly with recipient age and arterial pulse pressure.
- No significant correlation found with donor age, heart rate, mean arterial blood pressure, cyclosporine levels, or graft function parameters (creatinine, clearance, proteinuria).
Conclusions:
- Intrarenal Doppler indices are primarily hemodynamic, reflecting recipient vascular compliance rather than graft function.
- Intraindividual comparison of Doppler indices is recommended for long-term graft resistance monitoring.
Abstract:
Color Doppler sonography has been introduced for graft monitoring after renal transplantation. Little is known, however, about independent factors that have an impact on intrarenal Doppler indices as indicators for transplant dysfunction. Therefore, in this study, potential determinants of the resistive index (RI) and of the pulsatility index (PI) in 110 patients with stable renal allografts were studied. The mean RI and PI were 0.70 +/- 0.07 (range, 0.53 to 0.88) and 1.36 +/- 0.21 (range, 0.91 to 1.98), respectively. In multivariate regression analysis, RI and PI correlated significantly with age and arterial pulse pressure of the recipient. There was no correlation with donor age, heart rate, mean arterial blood pressure, and cyclosporine trough levels. Furthermore, parameters of kidney function, such as serum creatinine concentration, creatinine clearance rate, 51Cr-ethylenediaminetetraacetate clearance rate, and proteinuria, showed no significant correlation with the Doppler indices. The data indicate that intrarenal Doppler indices of the grafts are hemodynamic indices, primarily depending on the recipient-related vascular compliance rather than on the function of the graft. Therefore, only intraindividual comparison of the Doppler indices may be useful to detect potential changes of graft resistance during long-term follow-up.