Abstract
Retinal microvascular changes indicating microvascular dysfunction have been shown to be associated with chronic kidney disease (CKD) in cross-sectional studies, but findings were mixed in prospective studies. We aimed to evaluate the relationship between retinal microvascular parameters and incident CKD in an Asian population. We examined 1256 Malay adults aged 40–80 years from the Singapore Malay Eye Study, who attended both the baseline (2004–07) and the follow-up (2011–13) examinations and were free of prevalent CKD. We measured quantitative retinal vascular parameters (arteriolar and venular calibre, tortuosity, fractal dimension and branching angle) using a computer-assisted program (Singapore I Vessel Assessment, SIVA) and retinopathy (qualitative parameter) using the modified Airlie house classification system from baseline retinal photographs. Incident CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 + 25% decrease in eGFR during follow-up. Over a median follow-up period of 6 years, 78 (6.21%) developed CKD (70.5% had diabetes). In multivariable models, smaller retinal arterioles (hazards ratio [95% confidence interval] = 1.34 [1.00–1.78]), larger retinal venules (2.35 [1.12–5.94] and presence of retinopathy (2.54 [1.48–4.36]) were associated with incident CKD. Our findings suggest that retinal microvascular abnormalities may reflect subclinical renal microvascular abnormalities involved in the development of CKD.
Highlights
The retinal microvasculature provides an opportunity to study the systemic microvasculature non-invasively
No significant associations were observed between central retinal artery equivalent (CRAE), retinal Df, tortuosity and branching angle. In this population-based study, we observed that smaller retinal arterioles, larger retinal venules and presence of retinopathy were associated with an increased risk of CKD over a median follow up of 6 years, independent of potential confounders
These associations between smaller retinal arterioles, larger retinal venules and presence of retinopathy with incident CKD were stronger in participants with diabetes
Summary
The retinal microvasculature provides an opportunity to study the systemic microvasculature non-invasively. Several studies have reported cross-sectional associations between retinal microvascular changes (i.e. smaller retinal arterioles, presence of retinopathy signs) and CKD9–12. These associations, between retinal vascular caliber and incident CKD, have not been consistently replicated in prospective studies[13,14,15,16,17,18]. The prospective association between retinal geometry vascular parameters and incident CKD has not been evaluated before To address these limitations, we aimed to examine the association of a panel of retinal microvascular imaging markers with incident CKD in a population-based sample of Malay adults aged 40–80 years in Singapore
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