title: Association between retinopathy and cardiovascular disease in patients with chronic kidney disease (from the Chronic Renal Insufficiency Cohort [CRIC] Study).
abstract: Patients with chronic kidney disease experience co-morbid illnesses, including cardiovascular disease (CVD) and retinopathy. The purpose of the present study was to assess the association between retinopathy and self-reported CVD in a subgroup of the participants in the Chronic Renal Insufficiency Cohort study. For this observational, ancillary investigation, 2,605 Chronic Renal Insufficiency Cohort participants were invited to participate in the present study, and nonmydriatic fundus photographs in both eyes were obtained for 1,936 subjects. The photographs were reviewed in a masked fashion at a central photograph reading center. The presence and severity of retinopathy (diabetic, hypertensive, or other) and vessel diameter caliber were assessed using standard protocols by trained graders who were masked to the information about the study participants. A history of self-reported CVD was obtained using a medical history questionnaire. Kidney function measurements and traditional and nontraditional risk factors for CVD were obtained from the Chronic Renal Insufficiency Cohort study. A greater severity of retinopathy was associated with a greater prevalence of any CVD, and this association persisted after adjustment for the traditional risk factors for CVD. The presence of vascular abnormalities usually associated with hypertension was also associated with increased prevalence of CVD. We found a direct relation between CVD prevalence and mean venular caliber. In conclusion, the presence of retinopathy was associated with CVD, suggesting that retinovascular pathology might indicate macrovascular disease, even after adjustment for renal dysfunction and traditional CVD risk factors. This would make the assessment of retinal morphology a valuable tool in CKD studies of CVD outcomes.
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. juangrun@mail.med.upenn.edu
authors.forename: Juan E
authors.initials: JE
authors.lastname: Grunwald
authors.forename: Gui-Shuang
authors.initials: GS
authors.lastname: Ying
authors.forename: Maureen
authors.initials: M
authors.lastname: Maguire
authors.forename: Maxwell
authors.initials: M
authors.lastname: Pistilli
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Daniel
authors.forename: Judith
authors.initials: J
authors.lastname: Alexander
authors.forename: Revell
authors.initials: R
authors.lastname: Whittock-Martin
authors.forename: Candace
authors.initials: C
authors.lastname: Parker
authors.forename: Emile
authors.initials: E
authors.lastname: Mohler
authors.forename: Joan Chia-Mei
authors.initials: JC
authors.lastname: Lo
authors.forename: Raymond
authors.initials: R
authors.lastname: Townsend
authors.forename: Crystal Ann
authors.initials: CA
authors.lastname: Gadegbeku
authors.forename: James Phillip
authors.initials: JP
authors.lastname: Lash
authors.forename: Jeffrey Craig
authors.initials: JC
authors.lastname: Fink
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.forename: Harold
authors.initials: H
authors.lastname: Feldman
authors.forename: John Walter
authors.initials: JW
authors.lastname: Kusek
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.forename: Martha
authors.initials: M
authors.lastname: Coleman
authors.forename: Martin Gerard
authors.initials: MG
authors.lastname: Keane
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015331:Cohort Studies; D003930:Diabetic Retinopathy / Q000453:epidemiology*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D058437:Hypertensive Retinopathy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012171:Retinal Vessels / Q000473:pathology; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology