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Original Investigation
May 9, 2019

Association Between Progression of Retinopathy and Concurrent Progression of Kidney Disease: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

Author Affiliations
  • 1Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 2Kaiser Permanente Northern California, Oakland
  • 3Temple University, Philadelphia, Pennsylvania
  • 4University of Illinois at Chicago
  • 5University of Maryland, Baltimore
  • 6Case Western University, University Hospitals of Cleveland Medical Center, Cleveland, Ohio
  • 7Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
JAMA Ophthalmol. 2019;137(7):767-774. doi:10.1001/jamaophthalmol.2019.1052
Key Points

Question  Is progression of retinopathy associated with progression of kidney disease in patients with chronic kidney disease?

Findings  In this multicenter cohort study of 1583 patients with chronic kidney disease, fundus photographs obtained at baseline and a mean of 3.5 years later were assessed. Chronic kidney disease worsening was associated with worsening of retinopathy in univariable but not in multivariable analysis.

Meaning  The findings suggest that similar risk factors may be affecting the progression of both retinal and chronic kidney disease.

Abstract

Importance  Associations between retinopathy and kidney disease have been previously described. The association between the progression of retinopathy and concurrent progression of chronic kidney disease is unknown.

Objective  To assess the association between progression of retinopathy and concurrent progression of chronic kidney disease (CKD) among persons with CKD enrolled in a prospective cohort study.

Design, Setting, and Participants  A total of 1936 patients with chronic kidney disease enrolled in the multicenter, prospective Chronic Renal Insufficiency Cohort (CRIC) Study were invited to have 2 nonmydriatic fundus photography sessions separated by a mean (SD) of 3.5 (0.5) years. The study was conducted from May 12, 2006, to June 29, 2011. Data analysis was performed from March 16, 2016, to November 17, 2017.

Main Outcomes and Measures  Fundus photographs obtained at baseline and then at a follow-up at 3.5 years were reviewed by masked graders for presence and severity of retinopathy, and vessel calibers were assessed using standard protocols. The associations of the changes in retinal features with progression of CKD (50% estimated glomerular filtration rate [eGFR] loss or incident end-stage renal disease, and differences in eGFR slope in the same time period) were assessed with univariable and multivariable logistic regression models.

Results  Among 1583 CRIC participants who had baseline fundus photography, had additional follow-up in CRIC, and were at risk for retinopathy progression, 1025 patients (64.8%) had follow-up photography. The odds ratio (OR) for CKD progression associated with worsening of retinopathy in comparison with participants with stable retinopathy was 2.24 (95% CI, 1.28-3.91; P = .005) in univariable analysis among participants with baseline and follow-up photography. In the multivariable analysis, the OR was 1.62 (95% CI, 0.77-3.39; P = .20). The multiple imputation analysis provided similar results.

Conclusions and Relevance  Progression of retinopathy appears to be associated with progression of CKD on univariable analysis but not on multivariable analysis suggesting that similar risk factors may be affecting the progression of both retinal and chronic kidney disease.

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