Renal arterial pulsatility predicts progression of chronic kidney disease in chronic heart failure patients.

Chronic kidney disease (CKD) is frequent in CHF patients, and is associated with adverse prognosis. In CKD it has recently been reported that the assessment of renal Doppler pulsatility index (PI) correlates with the degree of intrarenal damage and is a predictor of subsequent renal function. In order to investigate whether an increased PI may correlate with the progression of CKD in CHF, 68 consecutive patients underwent renal ultrasonography. The focal zone of the pulsed Doppler was positioned at the level of the right renal segmental arteries. We determined the peak systolic velocity (V max), the end-diastolic velocity (V min) and the mean velocity (V mean) in order to calculate the dimensionless PI value: (V max −V min)/V mean. Renal function was assessed at baseline and after 6 months of follow-up. Estimated glomerular filtration rate (eGFR) was calculated according to the CKD-EPI equation. Absolute and percent difference between follow-up and baseline eGFR, (ΔeGFR and ΔeGFR%) and s-creatinine (Δs-Creat, Δs-Creat%) were calculated. Patients with PI above median (1.47) were significantly older, had higher NYHA class and left ventricular volumes and lower ejection fraction as compared with patients with low PI. At follow-up, patients with PI above median had on average a worsening of eGFR and s-creatinine. When dividing the study population according to median PI, we found that patients with higher PI levels had a significant worsening of CKD stage as compared with patients with lower PI. The main finding of the present study was that a high renal PI proved to be the only independent predictor of decline in kidney function in CHF patients over a six-month follow-up.