title: Bidirectional association of retinal vessel diameters and estimated GFR decline: the Beaver Dam CKD Study.
abstract: BACKGROUND
  Recent cross-sectional studies have reported an association between retinal vessel caliber and chronic kidney disease (CKD), but the direction of the association between these 2 processes is not clear. In a prospective study with multiple measurements of retinal vessel diameters and serum creatinine, we examined whether baseline retinal vessel diameter is associated with future risk of decreased kidney function, or vice versa.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  3,199 Wisconsin adults aged 43-84 years who were followed up prospectively for 15 years.
  
  
  METHODS
  Baseline retinal arteriolar and venular diameters for analysis 1 and baseline estimated glomerular filtration rate (eGFR) categories for analysis 2.
  
  
  METHODS
  For analysis 1, incident CKD, defined as eGFR <60 mL/min/1.73 m(2) accompanied by a 25% decrease in eGFR, during follow-up. For analysis 2, incident retinal arteriolar narrowing, defined as a central retinal arteriolar equivalent measurement <144.0 μm, and incident retinal venular dilation, defined as a central retinal venular equivalent measurement >243.8 μm.
  
  
  RESULTS
  Baseline retinal arteriolar and venular diameters were not associated with 15-year risk of incident CKD. After adjustment for age, sex, diabetes, hypertension, and other confounders, the multivariable HR of incident CKD comparing the narrowest with the widest quartile was 1.15 (95% CI, 0.74-1.80) for retinal arteriolar diameter and 1.05 (95% CI, 0.67-1.67) for retinal venular diameter. Similarly, there was no significant association between eGFR and 15-year risk of incident retinal arteriolar narrowing or retinal venular widening. Compared with eGFR >90 mL/min/1.73 m(2) (referent), the multivariable HR for those with eGFR <45 mL/min/1.73 m(2) was 1.66 (95% CI, 0.93-2.96) for incident retinal arteriolar narrowing and 0.60 (95% CI, 0.17-1.85) for retinal venular widening.
  
  
  CONCLUSIONS
  Lack of data for albuminuria and loss to follow-up.
  
  
  CONCLUSIONS
  Retinal vessel diameters and CKD may run together through shared mechanisms, but are not causally related.
authors: Department of Community Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
authors: Charumathi
authors: C
authors: Sabanayagam
authors: Anoop
authors: A
authors: Shankar
authors: Barbara E K
authors: BE
authors: Klein
authors: Kristine E
authors: KE
authors: Lee
authors: Paul
authors: P
authors: Muntner
authors: F Javier
authors: FJ
authors: Nieto
authors: Michael Y
authors: MY
authors: Tsai
authors: Karen J
authors: KJ
authors: Cruickshanks
authors: Carla R
authors: CR
authors: Schubert
authors: Peter C
authors: PC
authors: Brazy
authors: Josef
authors: J
authors: Coresh
authors: Ronald
authors: R
authors: Klein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012171:Retinal Vessels / Q000502:physiology / Q000503:physiopathology*; D014922:Wisconsin / Q000453:epidemiology