#5761 THE ASSOCIATION OF EGFR SLOPE WITH VISUAL IMPAIRMENT, RETINAL VESSEL DENSITY, AND EYE PATHOLOGIES IN THE EYE DETERMINANTS OF COGNITION (EYEDOC) STUDY

Abstract

Abstract Background and Aims Previous studies have identified chronic kidney disease (CKD) as a risk factor for poor ocular health. However, the effect of faster decline in estimated glomerular filtration rate (eGFR) on visual function, retinal markers, and eye conditions is unclear. We therefore examined the association of eGFR slope with visual function measures, retinal vessel density (VD), and common ocular pathologies in a bi-racial general population cohort. Method We studied 823 participants with normal kidney function or mild CKD (eGFR ≥ 60 ml/min per 1.73 m²) at baseline from the Eye Determinants of Cognition (EyeDOC) Study. Exposure was change in eGFR (ml/min per 1.73 m² per year) over 4 study visits between 1996 and 2019, calculated using linear mixed-effect models with unstructured covariance matrix. Outcomes (recorded between 2017 and 2019) were visual function (near visual acuity, presenting distance visual acuity, contrast sensitivity), retinal VD in the superficial, intermediate, and deep capillary plexus layers, and common ocular pathologies, such as retinopathy, age-related macular degeneration, and glaucoma. We used linear regression to model the associations of eGFR slope with visual function and retinal VD. We used logistic regression to study the association of eGFR slope with ocular pathologies. All models were adjusted for age, sex, race, education, smoking, body mass index, diabetes, hypertension, and hyperlipidemia. The models for retinal VD were additionally adjusted for signal strength index. Results In our study cohort, the mean age was 79 (±4) years with 62% females and 48% African Americans. The prevalence of diabetes and hypertension was 38% and 82%, respectively. The mean [SD] eGFR slope was −1.6 [0.6] ml/min per 1.73 m² per year. A faster eGFR decline of 1 ml/min per 1.73 m² per year was significantly associated with worse near visual acuity (0.04 logMAR [95% Confidence Interval 0.003; 0.08], p = 0.03), worse contrast sensitivity (−0.03 log [−0.05; −0.001], p = 0.01), lower VD in the deep capillary plexus layer (−0.99% per mm² [−1.96; −0.02], p = 0.04), and higher odds of retinopathy (odds ratio 2.44 [1.06; 6.63], p = 0.04). Associations of eGFR slope with the remaining measures of visual function and eye conditions were not significant. Conclusion In our bi-racial general population cohort with an eGFR ≥ 60 ml/min per 1.73 m² at baseline, a faster decline in eGFR was associated with worse visual function, reduced retinal vascular health, and higher odds of retinopathy. Our results support the potential usefulness of eGFR slope for risk assessment of ocular outcomes, even in patients with normal kidney function or mild CKD.