Renal resistive index: Beyond the hemodynamics

We read with great interest the original article entitled “Prognosticsignificance of the renal resistive index in the primary prevention of typeII diabetes” by Delsart et al1 In this issue of The Journal, the authorsinterestingly underlined the prognostic value of renal resistive index(RRI) in diabetic subjects and its role as an independent predictor ofa first cardiovascular or renal event.Similar conclusions were previously obtained by others in differentsubsets of patients (hypertension, chronic kidney disease,or heart failure), in which intrarenal hemodynamic alterationsshowed to be independent predictors of cardiovascular events.It is likely that the mechanisms underlying renal hemodynamicalterations in diabetics are similar to those involved in hypertensivesubjects and that “renal resistance indices reflect systemic rather thanrenal vascular damage,” as previously postulated by Heine et al.