Study On The Correlation Between AASI And Sym - AASI And Renal Artery Resistance Index In CKD Patients

Objective: Cardiovascular disease is the main cause of death in patients with chronic kidney disease. Atherosclerosis is the most powerful predictors of cardiovascular morbidity and mortality. The ambulatory arterial stiffness index (AASI) derived from ambulatory blood pressure (BP) monitoring (ABPM) was introduced as an index that not only reflects large atherosclerosis, but also predicts cardiovascular risk in different populations. And its improved indicators is the symmetric Ambulatory arterial stiffness index (Sym-AASI) which is gradually being concerned of the more effective predictor of cardiovascular events and it can eliminating the effects of dippers curve and the correlation coefficient. Renal resistance index (RRI) is an indicator of renal perfusion, and proven associated with CKD progression. Therefore, we investigated the relationship between the AASI and Sym-AASI with RRI in CKD patients.Methods: We collect data of patients with chronic kidney disease (CKD) from September 2012 to June 2014 who hospitalized at Nephrology Department of the First Affiliated Hospital of Kunming Medical University. According to the definition of CKD patients in Kidney Disease Outcome Quality Initiative (KDOQI) guidelines from the American Kidney Foundation (NKF), meet the conditions a total of 789 cases, average age (46.6±17.0), man(432). Collect detailed medical history of recruited patients, measure 24-hour ambulatory blood pressure monitoring (ABPM), collect 24h original blood pressure value of individual, calculate AASI and Sym-AASI; Measuring segmental artery resistance index of both kidneys use Color Doppler ultrasound for kidney; Collect patients’ blood routine, blood biochemistry,24 h urine protein quantitative after admission.Results: With RRI as the dependent variable, age, glomerular filtration rate (GFR), hemoglobin (HGB), Proteinuria (24-hour), uric acid (UA), body mass index (BMI), Defined Daily Dose(DDD), AASI and Sym-AASI as Independent variables, the application of Univariate correlation coefficients analysis, results showed that age, UA, DDD, AASI and Sym-AASI are linear correlation with RRI (P<0.01,all), And there are positive correlation. In addition, GFR (p< 0.01), HGB (p< 0.01) and RRI have negative correlation. However,24h Proteinuria quantitative and BMI (P> 0.05, both) with RRI no linear correlation.Then, the age, GFR, HGB,24h Proteinuria quantitative, UA, BMI, DDD, AASI, Sym - AASI and history of diabetes, smoking status, hypertension history together into the model, After applying multiple linear stepwise regression method, results showed that GFR, age, HGB, gender, history of diabetes and AASI have independent linear correlation with RRI (P<0.01, all), illustrating the above factors are independent influencing factors of RRI. And AASI (Beta=0.040) is stronger than other factors influence on RRI; GFR, HGB are likely weaker than other factors influence on RRI. But UA, BMI,24h Proteinuria quantitative, smoking status, DDD, hypertension history, Sym-AASI after entering the multivariate linear regression analysis model, all showed no correlation with RRI.Conclusion: AASI not Sym-AASI is independently associated with Renal Resistive Index in CKD patients; suggest that AASI may affect renal blood perfusion in patients with CKD. In addition, the GFR, age, HGB, gender, history of diabetes are also independent factors of RRI, these factors can also affect the renal blood perfusion for patients with chronic kidney disease (CKD).