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Association found between progression of retinopathy, kidney disease
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Researchers postulated that similar risk factors may affect the progression of retinopathy and chronic kidney disease after finding an association between the two.
Prior to this study, there was no known association between the progression of retinopathy and concurrent progression of chronic kidney disease (CKD), the authors said.
Researchers evaluated the data of 1,025 patients with CKD who were enrolled in the multicenter, prospective Chronic Renal Insufficiency Cohort Study. They included patients who underwent two fundus photography sessions, 3.5 years apart, which were reviewed by masked graders for both presence and severity of retinopathy as well as vessel calibers.
The association between the progression of retinopathy and CKD was evaluated using univariable and multivariable logistic regression models.
In the univariable analysis of participants with baseline and follow-up photography, the odds ratio for retinopathy progression associated with CKD progression was 2.24 (95% CI, 1.28-3.91; P = .005). The multivariable analysis revealed an odds ratio of 1.62 (95% CI, 0.77-3.39; P = .20).
Additionally, researchers found a statistically significant association between the progression of retinopathy and CKD in patients without diabetes (odds ratio, 3.42; P = .02).
The authors stated that the pathologic changes in diabetes could possibly affect the progression of CKD.
They concluded that because the link between CKD and retinopathy is not statistically significant after adjustment for known risk factors, the progression of both diseases may be facilitated by similar mechanisms.
Additionally, because a substantial prevalence and progression of retinopathy was found in patients with CKD, those with kidney disease should be monitored for eye disease, they said. – by Scott Buzby
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Carolyn E. Majcher, OD, FAAO
As optometrists, we have the unique advantage of being able to directly examine retinal vasculature in vivo. It has long been postulated that retinal vascular disease heralds widespread systemic microvascular dysfunction. Previous work has demonstrated an association between retinopathy and kidney disease. Results from this Chronic Renal Insufficiency Cohort study suggest that progression of retinopathy is associated with concurrent progression of CKD and that both entities are likely fueled by similar risk factors.
In this study, approximately 20% of participants with retinopathy progression over a mean of 3.5 years experienced a 50% decline in kidney function or developed end-stage disease requiring dialysis or kidney transplant. In addition, approximately 20% with deterioration of CKD experienced concurrent worsening of retinopathy.
These findings signify a need for vigilant monitoring and frequent fundus examination of those with known progression of CKD, as parallel progression to treatable retinopathy may occur. Additionally, close communication between optometrists and internists/nephrologists is of upmost importance, and retinopathy progression should be promptly reported. We must never forget that the eye is the window to the systemic circulatory system, and that retinopathy often reflects widespread microvascular disease.
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