Abstract
BackgroundRetinal microvascular signs may provide insights into the structure and function of small vessels that are associated with renal disease. We examined the relationship of retinal microvascular signs with both prevalent and incident end-stage renal disease (ESRD) in a multi-ethnic Asian population.MethodsA total of 5763 subjects (aged ≥40 years) from two prospective population-based studies (the Singapore Malay Eye Study and the Singapore Prospective Study) were included for the current analysis. Retinopathy was graded using the modified Airlie House classification system. Retinal vascular parameters were measured using computer-assisted programs to quantify the retinal vessel widths (arteriolar and venular caliber) and retinal vascular network (fractal dimension). Data on ESRD was obtained by record linkage with the ESRD cases registered by National Registry of Diseases Office, Singapore. Multi-variable adjusted regression analyses were performed to assess the associations of baseline retinal vascular parameters and prevalent and incident ESRD.ResultsAt baseline, 21(0.36%) persons had prevalent ESRD. During a median follow-up of 4.3 years, 33 (0.57%) subjects developed ESRD. In our analyses, retinopathy was associated with prevalent ESRD (multi-variable adjusted odds ratio [OR], 3.21, 95% confidence interval [CI]: 1.28–8.05) and incident ESRD (multi-variable adjusted hazard ratio [HR], 2.51, 95%CI: 1.14–5.54). This association was largely seen in person with diabetes (HR, 2.60, 95%CI: 1.01–6.66) and not present in persons without diabetes (HR, 1.65, 95%CI: 0.14–18.98). Retinal arteriolar caliber, retinal venular caliber and retinal vascular fractal dimension were not associated with ESRD.ConclusionRetinopathy signs in persons with diabetes are related to an increased risk of ESRD; however, other microvascular changes in the retina are not associated with ESRD.
Highlights
We examined the relationship of retinal microvascular signs with both prevalent and incident end-stage renal disease (ESRD) in a multi-ethnic Asian population
Retinopathy was associated with prevalent ESRD and incident ESRD
Retinopathy signs in persons with diabetes are related to an increased risk of ESRD; other microvascular changes in the retina are not associated with ESRD
Summary
End-stage renal disease (ESRD), is a costly and disabling condition with a high mortality rate. [1] The pathological processes underlying the development of ESRD are not well understood. [2,3] Microvascular alterations including hyalinosis and muscular hyperplasia [4] in the renal microvasculature are common histopathological findings in individuals with ESRD. [5] These microvascular abnormalities have been suggested to represent early pathological abnormalities in the kidney. [5] such microvascular changes occurring in the glomerular vascular bed cannot be visualised directly and non-invasively. [6]Since the retinal and renal circulations share similar anatomic and physiologic characteristics, [7,8,9] the retinal microvasculature provides an opportunity to study the renal microvasculature non-invasively. [13,14,15,16,17] For example, in the Beaver Dam Chronic Kidney Disease study, authors did not find any statistically significant association between retinal vessel diameters (retinal arteriolar narrowing and venular widening) and the decline in eGFR over time (S1 Table). This discrepancy may be attributed to the use of different surrogate markers for renal impairment, age distributions and ethnicity across populations. We examined the relationship of retinal microvascular signs with both prevalent and incident end-stage renal disease (ESRD) in a multi-ethnic Asian population
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