Retinal Microvascular Signs Are Associated with Chronic Kidney Disease in Persons with and without Diabetes

Abstract

Background/Aims: In persons with diabetes, retinal microvascular abnormalities are associated with chronic kidney disease (CKD). However, it is not clear if the same relationship applies in persons without diabetes. Methods: We examined 2,971 participants from a population-based study (240 with, 2,731 without diabetes). Retinal photographs were masked graded for retinal microvascular signs, and CKD was defined as estimated glomerular filtration rate (eGFR_MDRD) <60 ml/min/1.73 m². Results: Retinal microvascular signs were more frequent in persons with CKD. After adjusting for age, gender, systolic blood pressure and fasting plasma glucose, CKD was associated with both presence of retinopathy (odds ratio, OR, 1.2, 95% confidence interval, CI 1.0–1.5) and venular dilation (OR 1.2, 95% CI 1.0–1.5). These associations were similar in persons with and without diabetes. There was a significant trend for increasing magnitude of associations of retinopathy with increasing severity levels of CKD (p for trend 0.03). Conclusions: Retinal microvascular signs, namely retinopathy lesions and venular dilation, are associated with CKD both in persons with, and without diabetes. This supports the concept that retinal microvascular signs are indicators of generalized microvascular disease even in the absence of diabetes, and reinforces the link between retinal and renal microcirculations.

Estimated and Measured GFR Associate Differently with Retinal Vasculopathy in the General Population

“…With regard to retinopathy, previous studies have found a positive relationship with CKD in non-diabetic persons [30,31,34,35]. Our results indicate that the cross-sectional association between reduced GFR and retinopathy extends into the normal GFR range and that it is independent of microalbuminuria (table 3).…”

“…There are divergent results of investigations of the association between renal vessel diameters and CKD defined as eGFR crea <60 ml/min/1.73 m 2 . Whereas some studies have found an association between narrow retinal arteries or wider retinal veins and the odds of having CKD, others have not [30,31]. …”

Complete Blood Count and Retinal Vessel Calibers

“…Studying these retinal vascular caliber changes provides insight into parallel pathology that may occur in the systemic micro- and macro-circulations, with retinal arteriolar narrowing strongly associated with angiographically defined coronary artery occlusion,[12] reduced myocardial perfusion,[13] and greater aortic stiffness. [14] Wider venules are associated with chronic kidney disease,[15], [16] aortic calcification[17] and progression of cerebral small vessel disease [18]. Among people with diabetes, wider venular caliber is directly related to the presence and severity of diabetic retinopathy [19], [20]…”

Definition and Epidemiology of Arterial Disease

“…These changes are also observed in the paediatric and adolescent population [ 52 -54 ]. Retinal microvascular signs such as venular dilatation are associated with CKD both in the presence and absence of diabetes, thus reinforcing the link between renal and retinal microvasculature independently of diabetes [ 55 ].…”