Retinopathy and Chronic Kidney Disease in the Chronic Renal Insufficiency Cohort (CRIC) Study

Grunwald, Juan E.; Alexander, Judith; Ying, Gui Shuang; Maguire, Maureen G.; Daniel, Ebenezer; Whittock-Martin, Revell; Parker, Candace; McWilliams, Kathleen; Lo, Joan C.; Go, Alan S.; Townsend, Raymond R.; Gadegbeku, Crystal A.; Lash, James P.; Fink, Jeffrey C.; Rahman, Mahboob; Feldman, Harold I.; Kusek, John W.; Xie, Dawei; Jaar, Bernard G.

doi:10.1001/archophthalmol.2012.1800

Cited by 135 publications

(135 citation statements)

References 29 publications

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“…A detailed description of the CRIC study (7,8) and the methodology used to obtain and interpret retinal images were previously reported (4). All CRIC participants from six CRIC clinical sites in which six fundus cameras were deployed were offered participation in our study.…”

Section: Methodsmentioning

confidence: 99%

“…We previously reported a strong independent, cross-sectional association between the severity of retinopathy and the level of kidney dysfunction (4). Previous population studies have shown associations between baseline retinopathy and progression of CKD (5,6).The purpose of this Retinopathy in Chronic Renal Insufficiency (RCRIC) study was to extend these observations by evaluating the relationship between retinal vascular changes and renal disease progression among the well characterized participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study, a multicenter, long-term observational, prospective study in patients with CKD (7,8).…”

Section: Introductionmentioning

confidence: 97%

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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: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Retinopathy and Progression of CKD

Grunwald

Pistilli

Ying

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…Recently, studies have shown that the presence of diabetic retinopathy (DR) itself may leave patients at risk for diabetic nephropathy. [7][8][9][10][11] However, the specific prognostic factors of DR such as DR stage, presence of neovacularization (NV) or vitreous hemorrhage, and degree of nonperfusion area on fluorescein angiography (FA) that predict the progression of CKD have not yet been studied.…”

Section: Introductionmentioning

confidence: 99%

Ischemic diabetic retinopathy as a possible prognostic factor for chronic kidney disease progression

Lee

Sobrin

et al. 2014

Eye

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Purpose To assess the value of diabetic retinopathy (DR) severity as a possible predictive prognostic factor for the progression of chronic kidney disease (CKD). Patients and methods Retrospective cohort study. Patients (51) who were initially diagnosed with DR and CKD were enrolled and their medical records were evaluated. The following ophthalmic factors were assessed by fluorescein angiography at the initial visit: area of capillary nonperfusion, presence of neovascularization and vitreous hemorrhage, and DR grade. The effect of these factors on CKD progression over the 2-year period of the study, defined as doubling of serum creatinine or the development of end-stage renal disease requiring dialysis or renal transplant, was evaluated. Results The study included 51 patients with DR and CKD; of these, 11 patients (21.6%) were found to have proliferative DR (PDR) and seven patients (13.7%) had highrisk PDR at baseline. Patients with ischemic DR, who showed extensive capillary nonperfusion (Z10 optic disc areas) in the retina, had a greater risk for CKD progression (hazard ratio ¼ 6.64; P ¼ 0.002). Conclusion We found that extensive capillary nonperfusion in the retina greatly increased the risk of progression of CKD in patients with DR. This suggests that the retina and the kidney may have shared risk factors for microvascular disease secondary to diabetes mellitus, and emphasizes the need for a team approach to diabetes care.

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“…Retinopathy and nephropathy are most important microvascular complications in patients with diabetes. It is assumed that retinopathy and nephropathy occurs at the same time and that the severity of retinopathy parallels the presence and severity on nephropathy in diabetes mellitus [8,9]. In addition, it is suggested that relationship between renal abnormalities and retinopathy are more frequent in patients with type 1 diabetes than type 2 diabetes [10].…”

Section: Introductionmentioning

confidence: 99%