Bidirectional Association of Retinal Vessel Diameters and Estimated GFR Decline: The Beaver Dam CKD Study

Sabanayagam, Charumathi; Shankar, Anoop; Klein, Barbara E.K.; Lee, Kristine E.; Muntner, Paul; Nieto, F. Javier; Tsai, Michael Y.; Cruickshanks, Karen J.; Schubert, Carla R.; Brazy, Peter C.; Coresh, Josef; Klein, Ronald

doi:10.1053/j.ajkd.2010.11.025

Cited by 51 publications

(62 citation statements)

References 36 publications

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“…No significant association was observed for both venular or arteriolar diameters and risk of CKD progression when each of these two measurements was analyzed separately. This is consistent with a previous population-based study (15). However, when we looked at the ratio between the arterioles and venules, the largest ratio (highest quartile) was statistically significantly associated with future progression of kidney disease (risk of ESRD and steeper eGFR decline) that remained significant after multivariate adjustment for baseline kidney function.…”

Section: Discussionsupporting

confidence: 91%

“…The score, which is derived from the presence and severity of the above-mentioned abnormalities, is on an ordinal scale and is not a continuous variable. Scores were classified as normal (,14), very mild nonproliferative retinopathy (NPR; [14][15][16][17][18][19][20], NPR (35-53), and proliferative retinopathy (PR; .60). The score for the eye with more advanced retinopathy was used as the score of the participant; when photographs of only one eye were available, the score for that eye was used.…”

Section: Retinopathy and Vessel Caliber Assessment Protocolsmentioning

confidence: 99%

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Retinopathy and Progression of CKD

Grunwald

Pistilli

Ying

et al. 2014

Clinical Journal of the American Society of Nephrology

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Retinopathy and Vessel Caliber Assessment Protocolsmentioning

confidence: 99%

Retinopathy and Progression of CKD

Grunwald

Pistilli

Ying

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…34 The lowest quartile of CRAE was defined as the central retinal artery narrowing. 35 Similarly, the lowest quartile of the retinal vascular fractal dimension was defined as retinal vascular fractal dimension decreasing. The mean arterial blood pressure, the pulse pressure and the body mass index (BMI) were calculated using the following formulae: mean arterial blood pressure (mm Hg) = 1/3 systolic blood pressure+2/3 diastolic blood pressure; pulse pressure (mm Hg) = systolic blood pressure − diastolic blood pressure; BMI (kg m −2 ) = body weight per height 2 .…”

Section: Definitionsmentioning

confidence: 99%

Aortic stiffness is associated with the central retinal arteriolar equivalent and retinal vascular fractal dimension in a population along the southeastern coast of China

et al. 2015

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The objective of this study was to evaluate the association of the central retinal arteriolar equivalent (CRAE) and the retinal vascular fractal dimension, two quantitative parameters that reflect microcirculation, with aortic stiffness. In this cross-sectional study, we identified the cardiovascular risk factors in 2169 subjects using a health questionnaire, physical examinations and laboratory examinations. We evaluated the aortic stiffness using noninvasive brachial-ankle pulse wave velocity (baPWV) and assessed the microcirculatory alterations with CRAE and retinal vascular fractal dimension, which were measured using fundus photography and semiautomatic quantitative software, respectively. The increase in baPWV (Q1-Q4) correlated with an increased likelihood of the central retinal artery narrowing and a reduction in the retinal vascular fractal dimension. Further adjustment of the cardiovascular risk factors diminished the association between baPWV and CRAE, but increased the association between baPWV and retinal vascular fractal dimension. Elevated baPWV correlates with reduced CRAE and retinal vascular fractal dimension. Such a finding supports macrocirculation- and microcirculation-associated hypotheses.

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“…A meta-analysis of six population-based studies showed that retinal vessel caliber was associated to an increased risk of coronary artery disease in women, but not in men [11]. However, not all studies agree, and there are conflicting results in relation to the evolution of atherosclerotic lesions and retinal vessel caliber [12][13][14]. Cuspidi et al [15] and Masaidi et al [16] found no association between retinal vessel caliber and the target organ lesions studied (cardiac, vascular, and renal) in two hypertensive population.…”

Section: Introductionmentioning

confidence: 99%