Retinopathy and Progression of CKD

Abstract

Background and objectives Retinal abnormalities may be associated with changes in the renal vasculature. This study assessed the association between retinopathy and progression of kidney disease in participants of the Chronic Renal Insufficiency Cohort (CRIC) study.Design, setting, participants, & measurements This was a prospective study in which patients with CKD enrolled in CRIC had nonmydriatic fundus photographs of both eyes. All CRIC participants in six clinical sites in which fundus cameras were deployed were offered participation. Photographs were reviewed at a reading center. The presence and severity of retinopathy and vessel calibers were assessed using standard protocols by graders masked to clinical information. The associations of retinal features with changes in eGFR and the need for RRT (ESRD) were assessed.Results Retinal images and renal progression outcomes were obtained from 1852 of the 2605 participants (71.1%) approached. During follow-up (median 2.3 years), 152 participants (8.2%) developed ESRD. Presence and severity of retinopathy at baseline were strongly associated with the risk of subsequent progression to ESRD and reductions in eGFR in unadjusted analyses. For example, participants with retinopathy were 4.4 times (95% confidence interval [95% CI], 3.12 to 6.31) more likely to develop ESRD than those without retinopathy (P,0.001). However, this association was not statistically significant after adjustment for initial eGFR and 24-hour proteinuria. Venular and arteriolar diameter calibers were not associated with ESRD or eGFR decline. The results showed a nonlinear relationship between mean ratio of arteriole/vein calibers and the risk of progression to ESRD; participants within the fourth arteriole/vein ratio quartile were 3.11 times (95% CI, 1.51 to 6.40) more likely to develop ESRD than those in the first quartile (P,0.001).Conclusions The presence and severity of retinopathy were not associated with ESRD and decline in eGFR after taking into account established risk factors.

Association of Retinopathy with Chronic Kidney Disease in Diabetes Mellitus

“…They concluded presence and severity of DR may not provide any additional prognostic information regarding risk of CKD progression and vice versa which is similar with the current study. 12 Previously same observation was found in different studies. Goldstein et al showed that a decline in renal function was not followed by the same decline in retinopathy.…”

“…10 Stratton et al, found that there was a highly significant positive association of HbA1c with incidence and progression of retinopathy in both univariate and multivariate analysis. 12 Wong et al also found similar results. 15 Our study showed that the frequency of retinopathy is more in the age group of >50 years.…”

Serum Phosphate and Retinal Microvascular Changes: The Multi-Ethnic Study of Atherosclerosis and the Beaver Dam Eye Study

“…In multivariable analyses for both outcomes in the MESA, we hierarchically adjusted for gender, other demographics (age, race/ethnicity), cardiovascular comorbidities (diabetes, systolic blood pressure, and eGFR) and other mineral metabolites (FGF23 and PTH). Given the strong links between diabetes and CKD with retinopathy, 45,46 we conducted an a priori analysis that assessed whether the associations of serum phosphate with retinopathy presence and retinal vessel diameter in the fully adjusted model were modified by diabetes or eGFR by testing the significance of interaction terms. Due to effect modification by diabetes presence on the association of phosphate with prevalent retinopathy, we performed stratified analyses.…”

Diabetes retinopathy is a poor predictor for renal and cardiovascular outcomes in comparison with hypertensive retinopathy in patients with chronic kidney disease

“…Previous studies on the clinical significance of retinopathy on renal outcome produced a variety of different results; some studies showed no adverse effects [11] and others suggested an increased risk of renal failure [13,14]. In our study, patients with diabetes and DMR were associated with a faster eGFR decline after multivariate adjustment, and the slope of eGFR decline was steeper as the DMR grade worsened.…”

“…Several studies have evaluated the association between retinopathy and mortality or renal function decline in CKD patients [11,12], but the differences in clinical significance between DMR and HTNR have not been examined in CKD patients. The present study is the first to evaluate whether there is a different relationship between retinopathy and adverse outcomes in CKD patients with DMR and HTNR.…”