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Abstract Number: 1679

Different Cut-Offs for Renal Resistive Index Reflect Renal and Other Organ Involvement and Predict Worsening in SSc Patients

Cosimo Bruni1, Vanessa Maestripieri2, Giulia Tesei3, Marco Chiostri4, Serena Guiducci3, Silvia Bellando-Randone1, Maria Boddi4 and Marco Matucci-Cerinic3, 1Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Firenze, Italy, 2Department of Internal Medicine, Division of Medicine for Care Complexity III, University of Florence, Florence, Italy, 3Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy, 4Department of Heart and Vessels, Division of Cardiology I, University of Florence, Florence, Italy

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Doppler ultrasound, fibrosis, Renal disease, systemic sclerosis and vasculogenesis

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Session Information

Date: Monday, November 6, 2017

Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's – Clinical Aspects and Therapeutics Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Renal Resistive Index (RRI), measured by Doppler ultrasound, reflects changes in both renal vascular and tubular-interstitial compartments and systemic vascular compliance related to age and comorbidities (arterial hypertension, diabetes, hyperuricaemia, etc). As renal injury in younger decades may occur also for RRI <0.70, the use of this cut-off may underestimate. RRI was previously investigated in small SSc samples not considering possible confounding medical conditions. The objectives of the study were: to describe RRI in our SSc population, to test both fixed 0.70 RRI cut-off and SSc-age-adjusted cut-offs in reflecting renal and other organ involvement, to analyse the prognostic value of baseline RRI and RRI Δ change in predicting clinical worsening.

Methods: SSc patients classified through ACR/EULAR 2013 criteria, ≥18 years were enrolled after informed consent. Baseline Data on RRI, laboratory, instrumental and therapeutic features were retrospectively collected. SSc-age-adjusted pathologic cut-offs were created dividing the population in age quartiles and considering RRI values >75th percentile as pathologic (Table 1A). Clinical worsening was defined in case of any event listed in Table 1B. Data were analysed as appropriate with SPSS vers. 20.0.

Results: 250 SSc patients (mean disease duration 7.2±8.3 years) were eligible. RRI showed significant correlations with age (ρ=0.56, p<0.001) and creatinine clearance (ρ=-0.38, p<0.001), as well as significant associations with general population RRI determinants. When considering RRI absolute value and 0.70 cut-off, only comorbidities, renal function, sPAP and E/A, DLCO and late NVC pattern were associated. Conversely, new SSc-age-adjusted RRI cut-offs could not detect early renal damage but were significantly associated with various disease related skin and lung fibrotic manifestations, as well as vasculopathic complications (Table 2A). After a mean follow-up of 3.6±2.6 years, while RRI absolute values and 0.70 RRI cut-off showed no significant value, SSc-age-adjusted RRI cut-offs were significantly predictive for cardiac, lung and renal worsening (Table 2B). On the other hand, RRI Δ changes in 3 years (100 pts) and 5 years (60 pts), were not sensitive or predictive for worsening.  

Conclusion: in clinical practice, different age-SSc-adjusted or non-adjusted RRI cut-offs may be used to evaluate renal and extrarenal involvement, resembling DLCO for parenchymal and vascular lung involvement. These RRI cut-offs may be considered as possible predictors of kidney, lung and cardiac worsening in SSc patients.

 


Disclosure: C. Bruni, None; V. Maestripieri, None; G. Tesei, None; M. Chiostri, None; S. Guiducci, None; S. Bellando-Randone, None; M. Boddi, None; M. Matucci-Cerinic, None.

To cite this abstract in AMA style:

Bruni C, Maestripieri V, Tesei G, Chiostri M, Guiducci S, Bellando-Randone S, Boddi M, Matucci-Cerinic M. Different Cut-Offs for Renal Resistive Index Reflect Renal and Other Organ Involvement and Predict Worsening in SSc Patients [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/different-cut-offs-for-renal-resistive-index-reflect-renal-and-other-organ-involvement-and-predict-worsening-in-ssc-patients/. Accessed .
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