Key result
BMI >35 linked to ~4-fold higher rate of nondiagnostic renal artery duplex studies.
Why the study?
Although elevated BMI can negatively affect the diagnostic quality of renal artery duplex ultrasonography for assessing renal artery stenosis, the extent to which BMI affects diagnostic rates and the threshold for technical inadequacy were unknown.
Does an elevated body mass index (>35 kg/m2) reduce the diagnostic adequacy of renal artery duplex ultrasonography in patients evaluated for renal artery stenosis?
Cross-Sectional (n=244)
No
Does an elevated body mass index (>35 kg/m2) reduce the diagnostic adequacy of renal artery duplex ultrasonography in patients evaluated for renal artery stenosis?
Renal artery duplex ultrasonography has a 47.2% nondiagnostic rate in patients with a BMI > 35 kg/m2, making it an ineffective screening tool for this population and supporting a BMI threshold to improve resource utilization.
Answers are grounded in this paper and cite their sources.
Elevated BMI may limit renal artery duplex utility in obese patients; leaves open optimal imaging selection pending prospective validation.
Introduction: Renal artery duplex ultrasonography is an inexpensive, noninvasive, first-line imaging method to assess renal artery stenosis (RAS). However, bowel gas and body mass index (BMI) >40 kg/m 2 , can negatively affect the diagnostic quality of renal artery duplex ultrasonography. The extent BMI affects the diagnostic rates of renal artery duplex ultrasonography is unknown. This study assessed the effect of BMI on adequacy of renal artery duplex ultrasonography identifying a threshold for technically inadequate renal artery duplex evaluation, and to investigate the appropriateness of renal artery duplex as a screening test for patients with high BMI. Methods: The analysis included 244 renal artery duplex studies performed from May 4, 2021 to February 28, 2023 in inpatient and outpatient settings at an accredited noninvasive vascular lab. Mean BMI was compared between diagnostic and nondiagnostic groups using a 2-sided Student t -test. Frequency of diagnostic and nondiagnostic studies were compared qualitatively between BMI categories. A probability distribution was generated to project the expected nondiagnostic rate based on BMI category. Analyses were performed in MATLAB 2025a. Results: Of the 244 studies, 42 studies (17.2%) were nondiagnostic. Patients with nondiagnostic studies had significantly higher BMI than those with diagnostic studies (33.46 vs 27.74, P = <.01). Elevated BMI remains the predictor for technical inadequacy. The frequency of nondiagnostic studies increased to 47.2% for patients with BMI > 35 kg/m 2 , compared with 12.0% for patients with BMI < 35 kg/m 2 . Conclusion: Our study confirms the negative effect of BMI on the technical quality of renal artery duplex ultrasonography and provides new data quantifying this impact. High rates of the nondiagnostic studies in the BMI > 35 kg/m 2 group make renal artery duplex ultrasonography an ineffective screening tool for these patients. This work underscores the idea that establishing a BMI threshold for renal artery ultrasound can potentially improve resource utilization.
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Potter et al. (2026) conducted a cross-sectional in Renal artery stenosis evaluation (n=244). Elevated body mass index (BMI > 35 kg/m2) vs. Lower body mass index (BMI < 35 kg/m2) was evaluated on Nondiagnostic (technically inadequate) renal artery duplex ultrasonography study (p=<.01). Elevated BMI (>35 kg/m2) increased the frequency of nondiagnostic renal artery duplex studies to 47.2% vs 12.0% for BMI <35 kg/m2, with higher mean BMI in nondiagnostic studies (33.46 vs 27.74, P<.01).
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