Author(s): Yau JW, Xie J, Kawasaki R, Kramer H, Shlipak M, Klein R, Klein B, Cotch MF, Wong TY. Retinal arteriolar narrowing and subsequent development of CKD Stage 3: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Kidney Dis. 2011 Jul;58(1):39-46. doi: 10.1053/j.ajkd.2011.02.382. Epub 2011 May 6. PMID 21549464
Journal: American Journal Of Kidney Diseases : The Official Journal Of The National Kidney Foundation, Volume 58, Issue 1, Jul 2011
BACKGROUND Microvascular disease is a major pathogenic factor for chronic kidney disease (CKD) in persons with diabetes, but the role of microvascular disease in the development of CKD in the general population is unclear. The aim of this study is to examine whether microvascular disease precedes the development of CKD stage 3 in participants of the Multi-Ethnic Study of Atherosclerosis (MESA).
STUDY DESIGN Population-based cohort study.
SETTING & PARTICIPANTS MESA is a prospective cohort study of adults aged 45-84 years living in 6 US communities; 4,594 adults with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m(2) when they underwent retinal photography (visit 2: in 2002-2004) were examined.
PREDICTOR Retinal microvascular caliber measured from fundus photographs.
OUTCOMES Incident CKD stage 3 (ie, eGFR 1 mL/min/1.73 m(2) computed using the CKD Epidemiology Collaboration (CKD-EPI) equation.
RESULTS After a median follow-up of 4.8 years, there were 232 incident CKD stage 3 cases. Overall, retinal microvascular caliber was not associated with incident CKD stage 3. However, in race-stratified analysis, narrower arterioles in whites was associated with a higher risk of developing CKD stage 3 after adjusting for age, sex, blood pressure, diabetes, and other factors (HR, 1.78; 95% CI, 1.01-3.15; P = 0.04, lowest vs highest arteriolar caliber tertile). This association was seen even in whites without hypertension and diabetes (HR, 2.95; 95% CI, 1.10-7.98; P = 0.03). Retinal arteriolar caliber was not associated with incident CKD stage 3 in African Americans, Chinese, or Hispanics.
LIMITATIONS Analyses were based on a single eGFR measurement, and retinal microvascular caliber and eGFR measurements were not ascertained concurrently.
CONCLUSION Microvascular changes as manifest in the eye may contribute to the development of CKD stage 3 in whites.