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Bidirectional association of retinal vessel diameters and estimated GFR decline: the Beaver Dam CKD Study
Charumathi Sabanayagam1, Anoop Shankar, Barbara E K Klein
1Department of Community Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
Insights
Retinal vessel caliber and chronic kidney disease (CKD) are not causally linked. This prospective study found no evidence that baseline retinal vessel diameter predicts future CKD risk or vice versa.
Area of Science:
- Ophthalmology
- Nephrology
- Epidemiology
Background:
- Cross-sectional studies suggest an association between retinal vessel caliber and chronic kidney disease (CKD).
- The causal direction of this relationship remains unclear.
- This study investigates the prospective association between retinal vessel diameter and kidney function.
Purpose of the Study:
- To determine if baseline retinal vessel diameter predicts the future risk of developing CKD.
- To assess if baseline kidney function predicts future changes in retinal vessel caliber.
- To clarify the etiological relationship between retinal vasculature and renal function.
Main Methods:
- A population-based prospective cohort study involving 3,199 Wisconsin adults aged 43-84 years.
- Follow-up duration of 15 years with multiple measurements of retinal vessel diameters and serum creatinine.
- Analysis 1: Baseline retinal arteriolar/venular diameters predicting incident CKD. Analysis 2: Baseline estimated glomerular filtration rate (eGFR) categories predicting incident retinal arteriolar narrowing or venular widening.
Main Results:
- No significant association was found between baseline retinal vessel diameters and the 15-year risk of incident CKD.
- The multivariable hazard ratio for incident CKD comparing the narrowest to widest retinal arteriole quartile was 1.15 (95% CI, 0.74-1.80).
- No significant association was observed between baseline eGFR categories and the risk of incident retinal arteriolar narrowing or venular widening.
Conclusions:
- Retinal vessel diameters and CKD do not appear to have a direct causal relationship.
- The observed associations may be mediated by shared underlying mechanisms.
- Limitations include lack of albuminuria data and participant loss to follow-up.
Background:
Recent cross-sectional studies have reported an association between retinal vessel caliber and chronic kidney disease (CKD), but the direction of the association between these 2 processes is not clear. In a prospective study with multiple measurements of retinal vessel diameters and serum creatinine, we examined whether baseline retinal vessel diameter is associated with future risk of decreased kidney function, or vice versa.
Study Design:
Population-based cohort study.
Setting & Participants:
3,199 Wisconsin adults aged 43-84 years who were followed up prospectively for 15 years.
Predictor:
Baseline retinal arteriolar and venular diameters for analysis 1 and baseline estimated glomerular filtration rate (eGFR) categories for analysis 2.
Outcomes & Measurements:
For analysis 1, incident CKD, defined as eGFR <60 mL/min/1.73 m(2) accompanied by a 25% decrease in eGFR, during follow-up. For analysis 2, incident retinal arteriolar narrowing, defined as a central retinal arteriolar equivalent measurement <144.0 microm, and incident retinal venular dilation, defined as a central retinal venular equivalent measurement >243.8 microm.
Results:
Baseline retinal arteriolar and venular diameters were not associated with 15-year risk of incident CKD. After adjustment for age, sex, diabetes, hypertension, and other confounders, the multivariable HR of incident CKD comparing the narrowest with the widest quartile was 1.15 (95% CI, 0.74-1.80) for retinal arteriolar diameter and 1.05 (95% CI, 0.67-1.67) for retinal venular diameter. Similarly, there was no significant association between eGFR and 15-year risk of incident retinal arteriolar narrowing or retinal venular widening. Compared with eGFR >90 mL/min/1.73 m(2) (referent), the multivariable HR for those with eGFR <45 mL/min/1.73 m(2) was 1.66 (95% CI, 0.93-2.96) for incident retinal arteriolar narrowing and 0.60 (95% CI, 0.17-1.85) for retinal venular widening.
Limitations:
Lack of data for albuminuria and loss to follow-up.
Conclusions:
Retinal vessel diameters and CKD may run together through shared mechanisms, but are not causally related.
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