The relationship between renal resistive index and simple hematologic indices in patients with chronic kidney disease

ABSTRACT: Introduction – The renal resistive index (RRI) in Doppler ultrasonography is a useful marker for measuring the blood flow changes in kidney diseases as well as showing tubulointerstitial damage. Although there have been many studies on the relationship between RRI increase and kidney damage, only a few provide information on RRI and inflammation markers. This study aimed to compare RRI with blood inflammatory markers derived from hemogram in patients with chronic kidney disease (CKD). Matarial and Method – Ninety (33 female, 57 male) CKD patients who followed up at a nephrology clinic between January 2017 and December 2018 were included in this retrospective study. The RRI, serum creatinine, C-reactive protein (CRP), complete blood count results, leukocyte count (WBC), neutrophil to lymphocyte ratio (NLR), monocyte or lymphocyte (MLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV) and red cell distribution width (RDW) values of each patient were recorded. The eGFR was calculated with a CKD-EPI formula. Results – The mean age of the patients was 55.24 ± 14.35 years. Regarding the comparison of the RRI with age and serum CRP, a statistically significant positive relationship was found (r = .398, p = .001; r = .365, p = .001, respectively).The mean eGFR was found to be 42.47 ± 26.57 ml / min / 1.73 m2. A statistically significant negative correlation was found between the RRI and the eGFR (r = -.312, p = .003). When the RRI was compared with the WBC and the PLR, no statistically significant relationship was found (p = .229, p = .45, respectively). However, statistically significant positive relationships were found when the RRI was compared to the NLR and the MLR, a(r = .259, p = .014 / r = .228, p = .031, respectively). Additionally, there was a statistically significant positive relationship between the RRI and the RDW (p = .001, r = .383). In contrast, there was no relationship between the MPV and the RDW (p > .05). Conclusion – The negative relationship between the RRI and the eGFR in CKD patients show that the resistive index may determine the level of renal damage. OZ: Giris – Doppler ultrasonografideki renal rezistif indeks (RRI), bobrek hastaliklarinda kan akimi degisikliklerini olcmede ve tubulointerstisyel hasari gostermede yararli bir belirtectir. RRI artisi ile bobrek hasari arasindaki iliskinin gosterildigi bircok calisma mevcut olmasina ragmen RRI ile inflamasyon belirtecleri arasinda az sayida literatur bilgisi bulunmaktadir. Notrofil/lenfosit orani (NLR), kronik bobrek hastaligi (KBH) hastalarinda inflamasyon belirteclerinden biridir. NLR ve trombosit/lenfosit orani (PLR), hemodiyaliz hastalarinda inflamasyon ile iliskili bulunmustur. Ayrica ortalama platelet volum (MPV) hipertansiyon, ateroskleroz ve bobrek hastaliginda artmis komorbidite ile iliskilidir. eGFR ile MPV arasinda negatif iliski gosterilmistir. Kirmizi hucre dagilim genisligi (RDW), son donem bobrek yetmezligi hastalarinda sistemik inflamasyon ve ateroskleroz ile iliskili bulunmustur. Calismamizin amaci; KBH hastalarinda RRI ile kandaki inflamatuar belirteclerin karsilastirilmasidir. Gerec ve yontem – Calisma retrospektif olarak planlandi. Ocak 2017 ile Aralik 2018 tarihleri arasinda Canakkale Onsekiz Mart Universitesi Tip Fakultesi Hastanesi Nefroloji klinigine basvuran ve KBH saptanan hastalarin dosyalari incelendi. Her bir hastanin RRI, serum kreatinin, CRP ve tam kan sayimi sonuclari lokosit sayisi (WBC), NLR, monosit/lenfosit (MLR), PLR, MPV ve RDW degerleri kaydedildi. CKD-EPI formulu ile eGFR hesaplandi. Bulgular – Calismaya 90 hasta (33 kadin) dahil edildi. Hastalarin yas ortalamasi 55,24 ± 14,35 saptandi. Hastalardaki RRI; yas ve serum CRP ile karsilastirildiginda istatistiksel anlamli pozitif iliski saptandi (sirasiyla r=0.398, p=0.001; r=0.365, p=0.001). eGFR ortalamasi 42,47 ± 26,57 ml/dk/1,73 m2 bulundu. RRI ile eGFR arasinda istatistiksel anlamli negatif yonde iliski bulundu (r=-0.312, p=0.003). RRI; WBC ve PLR ile karsilastirildiginda istatistiksel anlamli bir iliski bulunamadi ( sirasiyla p= 0.229, p=0.45). RRI ile NLR ve MLR karsilastirildiginda istatistiksel anlamli ve pozitif yonde bir iliski saptandi ( sirasi ile r=0.259, p=0.014/ r = 0.228, p = 0.031). RRI ile RDW arasinda istatistiksel anlamli ve pozitif yonde iliski saptandi (p=0.001, r=0.383). MPV ve RDW arasinda istatistiksel anlamli iliski bulunmadi (p > 0.05). Sonuc – Calismamizda KBH hastalarinda RRI ile eGFR arasinda negatif iliskinin saptanmasi,rezistif indeksin renal hasarin duzeyini belirledigini gostermektedir. RRI ile kandaki bazi inflamatuar belirtecler (CRP, NLR MLR, RDW ) arasinda istatistiksel anlamli iliski saptandigi halde diger belirtecler (WBC, PLR, MPV) ile iliskisi bulunmamasi, bu alanda prospektif calismalarin yapilmasina ihtiyac oldugunu gostermektedir. Anahtar Kelimeler: Renal rezistif indeks, basit hematolojik gostergeler, kronik bobrek hastaligi