Similarities and differences in early retinal phenotypes in hypertension and diabetes

Grosso, Andrea; Cheung, Ning; Veglio, Franco; Wong, Tien Yin

doi:10.1097/hjh.0b013e3283496655

Cited by 45 publications

(28 citation statements)

References 97 publications

(135 reference statements)

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“…Interestingly, all of the factors described above additionally influence the microcirculation and contribute to intraglomerular pressure. [10][11][12][13][14][15][16] Thus, it is not surprising that renal microvascular pathology has been considered an important factor in CKD progression. 17 One pathophysiological aspect of the microcirculation is vascular remodeling in small arteries, including microvascular narrowing.…”

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confidence: 99%

Microcirculatory Marker for the Prediction of Renal End Points

2014

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T he prevalence of chronic kidney disease (CKD) has increased during the past years worldwide, 1 imposing a major burden on health-care systems. It is important to prevent CKD, thereby to reduce the need for renal replacement therapy and the rising morbidity and mortality associated with end-stage renal disease.2 Therefore, an efficient individual prediction of CKD progression is warranted.Several factors are involved in CKD progression, including baseline renal function, age, ethnicity, diabetes mellitus, blood pressure, use of renin-angiotensin system (RAS) blocker, and albuminuria.3-9 Despite these single predictive factors, an individual prediction of CKD progression remains difficult. Interestingly, all of the factors described above additionally influence the microcirculation and contribute to intraglomerular pressure.10-16 Thus, it is not surprising that renal microvascular pathology has been considered an important factor in CKD progression. 17 One pathophysiological aspect of the microcirculation is vascular remodeling in small arteries, including microvascular narrowing. 18,19 The latter can be assessed by noninvasive retinal vessel analysis.20,21 Narrow retinal arterioles are associated with age, black race, hypertension, and albuminuria. Ooi et al 22 and our group described narrow retinal arteries in patients with advanced CKD. 23,24 Similar to systemic arteriolar narrowing, the retinal and preglomerular arterioles could show the same effects.25 Narrow preglomerular arterioles increase intraglomerular pressure and contribute to the glomerular defect, determined by albuminuria, as has been demonstrated in spontaneously hypertensive rats and in patients with diabetes mellitus. [25][26][27][28] We hypothesize that retinal arteriolar narrowing predicts CKD progression and subsequently renal end points. Moreover and of importance to clinical practice, we hypothesize that Abstract-Retinal arteriolar narrowing reflects aging, hypertension, chronic kidney disease (CKD), and other vascular processes. We examined the predictive value of retinal arteriolar narrowing alone and in combination with albuminuria on renal disease progression in CKD. A white CKD stage 2 to 4 cohort of 164 men and women (60.8±13.8 years) underwent retinal photography and determination of albuminuria. The calibers of all retinal arterioles were measured after digital conversion of the photographs. Cases of incident renal end points defined as 50% renal function loss and start of renal replacement therapy were identified and validated by case record reviews. Over an average period of 1410 (range, 106-1606) days, 25 patients with CKD had incident renal end points. Kaplan-Meier analysis revealed that patients with CKD within the tertile of narrowest arterioles had more renal end points (log-rank P<0.001). Cox regression analysis confirmed this before (β=1.183±0.411) and after adjusting for age and baseline renal function (β=1.204±0.416). With respect to renal end points, a significant interaction was present between narrow arterioles and a...

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confidence: 99%

Microcirculatory Marker for the Prediction of Renal End Points

2014

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“…If fundus images were unavailable or ungradable for one eye, the retinopathy level from the other eye was used. Since retinopathy signs in the presence of diabetes and hypertension share many similarities, 22 care was taken not to attribute an underlying cause of the retinopathy but rather to consider concomitant conditions which co-occurred with it.…”

Section: Methodsmentioning

confidence: 99%

Mortality in Older Persons with Retinopathy and Concomitant Health Conditions

et al. 2016

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Objective To assess in older persons with concomitant health conditions the impact of retinopathy on mortality. Design Population-based prospective cohort study. Participants 4966 individuals aged 67–96 years old (43.2% male) from the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-RS). Methods Retinopathy was evaluated from digital fundus images (2002–2006) using the modified Airlie House adaptation of the Early Treatment Diabetic Retinopathy Study protocol. Mortality was assessed through September 2013 (cause-of-death assigned through 2009). Cox proportional hazards regression models, with age as the time scale, estimated the association between retinopathy and death while controlling for risk factors and the presence of concomitant health conditions. Main Outcome Measures Mortality from all-causes and cardiovascular disease (CVD). Results Among the 4966 participants, 503 (10.1%) had diabetes and 614 (12.4%) had retinopathy at baseline. A subset of these, 136 (2.7%), had both diabetes and retinopathy. After a median follow-up of 8.6 years, 1763 persons died, 276 (45.0%) with retinopathy and 1487 (34.2%) without retinopathy, of whom 76 and 162 persons, respectively, also had diabetes. There were 366 deaths from CVD through 2009; 72 (11.7%) in persons with retinopathy and 294 (6.8%) without retinopathy. In multivariable analyses, retinopathy was significantly associated with all-cause mortality [Hazard Ratio (HR) 1.26 (95% Confidence Interval (CI): 1.10, 1.43); p<0.01] and CVD-related mortality [HR 1.57 (95% CI: 1.20, 2.06); p<0.01]. Findings were more striking in men: all-cause HR 1.33 (95% CI: 1.11, 1.60) and CVD HR 1.81 (95% CI: 1.25, 2.63). Risk of mortality was further increased among those with retinopathy concomitant with microalbuminuria [all-cause HR 1.70 (95% CI: 1.03, 2.23) and CVD HR 2.04 (95% CI: 1.27, 3.28)] and those with retinopathy, microalbuminuria and diabetes [all-cause HR 2.01 (95% CI: 1.22, 3.31) and CVD HR 5.24 (95% CI: 1.91, 14.42)]. History of clinical stroke increased the risk of CVD-related mortality among persons with retinopathy [HR 3.30 (95% CI: 2.05, 5.32)], particularly those with retinopathy and diabetes [HR 5.38 (95% CI: 1.80, 16.06)]. Conclusions Even minimal retinopathy was a significant predictor of increased mortality in older persons, particularly men, irrespective of diabetes status. Persons with retinopathy may warrant closer clinical management of general health.

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“…4 Moreover, diabetes mellitus clearly has a significant effect on both retinopathy signs (as shown in Nonetheless, the Ibaraki Prefectural Health Study provides welcoming data on the link between retinopathy signs and long-term cardiovascular mortality risk. The findings are in keeping with previous studies 4,5 and support the notion that retinopathy signs are specific biomarkers for cardiovascular disease, above and beyond traditional risk factors, even in apparently normotensive people. Future studies are needed to determine whether incorporating retinal photography in routine clinical assessment could improve the prediction of cardiovascular disease.…”

Section: To the Editormentioning

confidence: 97%