title: Retinal arteriolar caliber and urine albumin excretion: the Multi-Ethnic Study of Atherosclerosis.
abstract: BACKGROUND
  Changes in retinal microvascular caliber, which occur prior to onset of retinopathy, may indicate presence of kidney damage.
  
  
  METHODS
  This study examined the association between retinal arteriolar [central retinal artery equivalent (CRAE)] and venular caliber [central retinal venule equivalent (CRVE)] and presence of albuminuria (micro- or macroalbuminuria) among participants of the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort of adults aged 45-84 years without baseline clinical cardiovascular disease. During the second MESA exam, digital fundus photography was completed in 5897 participants who provided spot urine specimens. Albuminuria was defined by spot urine albumin/creatinine ratios ≥ 30 mg/g. Multivariable adjusted odds of albuminuria by quintiles of CRAE and CRVE were determined using logistic regression. Analyses were repeated after stratifying by presence of type 2 diabetes.
  
  
  RESULTS
  Albuminuria was noted in 11.5% (n = 675) and included 584 subjects with microalbuminuria and 91 with macroalbuminuria. A significant U-shaped pattern was seen with higher prevalence of albuminuria across quintile extremes in CRAE (15.7, 8.8 and 10.6% in CRAE Quintiles 1, 3 and 5, respectively; P <0.0001). After adjustment for covariates, both narrower CRAE [odds ratios (OR) 1.55; 95% confidence interval (CI) 1.17-2.04, Quintile 1 versus 3) and wider CRAE (OR 1.44; 95% CI 1.07-1.93, Quintile 5 versus 3) were significantly associated with albuminuria. Associations appeared substantially stronger in adults with than without type 2 diabetes but the interaction term for diabetes and CRAE on presence of albuminuria did not meet statistical significance (P = 0.3). No association was noted between CRVE quintiles and albuminuria.
  
  
  CONCLUSIONS
  Albuminuria is associated with narrower and wider arteriolar caliber. Future studies should determine whether variation in arteriolar caliber predicts incident albuminuria and whether associations are mediated by hypertension and diabetes. Such information could further clarify early microvascular processes in the pathogenesis of kidney disease.
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Stella
authors.initials: S
authors.lastname: Awua-Larbi
authors.forename: Tien Y
authors.initials: TY
authors.lastname: Wong
authors.forename: Mary Frances
authors.initials: MF
authors.lastname: Cotch
authors.forename: Ramon
authors.initials: R
authors.lastname: Durazo-Arvizu
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.forename: Barbara E K
authors.initials: BE
authors.lastname: Klein
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.forename: Joao
authors.initials: J
authors.lastname: Lima
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D001160:Arterioles / Q000473:pathology*; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012164:Retinal Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D012307:Risk Factors; D015996:Survival Rate