Table 2.
Retinal vascular metrics to predict incident or progressive CKD
| Study | Country | N | Population and mean age | Retinal metric | Clinical outcome | Hypertension | Mean BP | Diabetes | Index serum creatinine level or eGFR | Follow-up duration | Results |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Wong et al.58 Prospective population-based cohort |
United States | 10,056 | White and African American adults with eGFR >60 ml/min per 1.73 m2 60 yr |
AVR | Incident renal dysfunction: rise in serum creatinine level by ≥35 μmol/l or hospital admission/death coded for renal disease | 50% | 127/70 mm Hg | 22% | 80 μmol/l | 6 yr | 3% developed CKD Smallest AVR associated with a greater change in serum creatinine level (4 μmol/l vs. 2 μmol/l) |
| Wong et al.61 Prospective population-based cohort |
United States | 557 | Type 1 diabetic patients with eGFR >90 ml/min per 1.73 m2 and proteinuria <0.3 g/l 31 yr |
CRAE CRVE |
Incident renal insufficiency: eGFR <60 ml/min per 1.73 m2 Incident gross proteinuria: >0.3 g/l |
No data | 120/76 mm Hg | 100% | No data | 16 yr | 20% developed CKD 33% developed proteinuria Widest CRVE quartile associated with the increased incidence of CKD and proteinuric CKD: adjusted RR 1.5 (1.05–2.2) Proteinuria: adjusted RR 1.5 (1.2–2.0) No association for CRAE |
| Edwards et al.62 Prospective population-based cohort |
United States | 1394 | Adults aged >65 yr 78 yr |
AVR | Change in serum creatinine level Decline in renal function: increase in serum creatinine level by ≥27 μmol/l and fall in eGFR by ≥20% |
57% | 131/67 mm Hg | 17% | 89 μmol/l 70 ml/min |
4 yr | 4%–5% had a significant increase in serum creatinine level or fall in eGFR AVR showed no associations with changes in renal function Retinopathy associated with a higher risk of decline in renal function: adjusted OR 2.8–3.2 vs. no retinopathy |
| Sabanayagam et al.63 Prospective population-based cohort |
United States | 3199 | White adults with eGFR >60 ml/min per 1.73 m2 59 yr |
CRAE CRVE |
Incident CKD: eGFR <60 ml/min per 1.73 m2 and 25% decrease from baseline | 45% | 130/78 mm Hg | 9% | 85 ml/min | 15 yr | 5% developed CKD No association of CRAE or CRVE with incident CKD No association with eGFR and incident CRAE narrowing or CRVE widening |
| Yau et al.64 Prospective population-based cohort |
United States | 4594 | Multi-ethnic adults with eGFR >60 ml/min per 1.73 m2 64 yr |
CRAE CRVE |
Incident CKD: eGFR <60 ml/min per 1.73 m2 | 40% | 127/71 mm Hg | 11% | 76 ml/min | 4.8 yr | 5% developed CKD Narrowest CRAE tertile associated with incident CKD in white patients only: adjusted HR 1.78 (1.01–3.1) vs. widest; increased to 2.95 when analyzing those without hypertension or diabetes No association with CRVE |
| Baumann et al.65 Prospective |
Germany | 141 | Adults with stage 2–4 CKD 61 yr |
CRAE | Progression of CKD: 50% decline in eGFR or start of RRT |
No data | 137/76 mm Hg | 46% | 48 ml/min | 3.9 yr | 17% had progression of CKD Narrowest CRAE tertile associated with progression of CKD: adjusted OR 3 (1.2–7.5) vs. widest CRAE Narrowest CRAE in the presence of albuminuria associated with a 10-fold increased risk of CKD progression as compared with a 3-fold risk seen with narrow CRAE or albuminuria alone |
| Grunwald et al.66 Prospective population-based cohort |
United States | 1852 | Adults with eGFR 20–70 ml/min per 1.73 m2 62 yr |
AVR CRAE CRVE |
Progression of CKD: ESRD/RRT, change in eGFR slope |
90% | 130/80 mm Hg | 47% | 40 ml/min | 2.3 yr | 8% developed ESRD and overall eGFR decline was 0.53 ml/min per 1.73 m2 Higher AVR associated with ESRD and steeper eGFR decline: adjusted HR 3.1 (1.5–6.4) No associations with CRAE and CRVE |
| Yip et al.67 Prospective population-based cohort |
Singapore | 5763 | Malay adults 55 yr |
AVR CRAE CRVE Df |
Incident ESRD: defined by start of RRT | 55% | 140/70 mm Hg | 34% | 77 ml/min | 4.3 yr | 0.4% developed ESRD No associations for vascular metrics and the risk of ESRD in adjusted analyses Retinopathy predicted ESRD |
| Yip et al.68 Prospective population-based cohort |
Singapore | 1256 | Malay adults 56 yr |
CRAE CRVE Tortuosity Df Branching angles |
Incident CKD: eGFR <60 ml/min per 1.73 m2 | 58% | 150/80 mm Hg | 25% | 80 ml/min | 6 yr | 6% developed incident CKD Narrower CRAE associated with incident CKD: adjusted HR 1.3 (1.00–1.78) as a continuous variable Widest CRVE tertile associated with incident CKD: adjusted HR 2.4 (1.1–5.9) vs. narrowest CRVE No other vascular metrics associated with incident CKD |
| McKay et al.69 Prospective population-based cohort |
Scotland | 1068 | Adults with eGFR ≥60 ml/min per 1.73 m2 63 yr |
CRAE CRVE Tortuosity Df Branching angles |
Change in eGFR: Progressors: eGFR <60 ml or ≥15% decline Nonprogressors: <10% decline |
No data | 138/77 mm Hg | 100% | 94 ml/min | 3 yr | 31% had progressive CKD No baseline retinal metric predicted progression of CKD in unadjusted or adjusted analyses |
AVR, arteriole-to-venule ratio; BP, blood pressure; CKD, chronic kidney disease; CRAE, central retinal arteriolar equivalent, CRVE, central retinal venular equivalent; Df, fractal dimension; eGFR, estimated glomerular filtration rate; ESRD, end-stage renal disease; HR, hazard ratio; OR, odds ratio; RR, risk ratio; RRT, renal replacement therapy.
All values are mean.