Renal resistive index as an indicator of the presence and severity of anemia and its future development in patients with hypertension

We examined whether renal resistive index (RI), a simple index of renal vascular resistance, is associated with the presence and severity of anemia, and can predict the future development of anemia in patients with hypertension.

We retrospectively examined 175 patients with hypertension (mean age 67 ± 11 years, 32-85 years, 134 males) who underwent renal ultrasonography. Anemia was defined as a reduction in the concentration of hemoglobin <13.0 g/dL for men and <12.0 g/dL for women. Renal RI was measured in the interlobar arteries.

Anemia was present in 37% of men and 34% of women. The mean estimated glomerular filtration rate (eGFR) was 58 ± 23 ml/min/1.73 m² (median: 56 ml/min/1.73 m², range: 16-168 ml/min/1.73 m²) and the mean renal RI was 0.70 ± 0.09 (median: 0.70, range: 0.45-0.92). Proteinuria was present in 29% of patients. Both eGFR and renal RI correlated significantly with hemoglobin levels. In the stepwise multivariate linear regression analysis, renal RI was associated with hemoglobin levels independently of potential confounders including eGFR. During the follow-up period (median: 959 days, range: 7-3595 days), Kaplan–Meier curves demonstrated that patients with renal RI above the median value had a higher incidence of the future development of anemia than other patients. Cox regression analysis showed that renal RI (hazard ratio 1.18, 95% CI 1.02-1.37 per 0.05 rises in renal RI, p =0.03) and the presence of proteinuria were (hazard ratio 1.80, 95% CI 1.08-3.01, p =0.03) were independently associated with the future development of anemia after correcting for confounding factors.

Measurement of renal RI can be useful for elucidating the pathogenesis of anemia and for inferring its potential risk in patients with hypertension.