title: Retinopathy and CKD as predictors of all-cause and cardiovascular mortality: National Health and Nutrition Examination Survey (NHANES) 1988-1994.
abstract: BACKGROUND
  Retinopathy is associated with increased mortality risk in general populations. We evaluated the joint effect of retinopathy and chronic kidney disease (CKD) on mortality in a representative sample of U.S. adults.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  7,640 adults from NHANES (National Health and Nutrition Examination Survey) 1988-1994 with mortality linkage through December 31, 2006.
  
  
  METHODS
  CKD, defined as low estimated glomerular filtration rate (<60 mL/min/1.73 m2) or albuminuria (urine protein-creatinine ratio ≥30 mg/g), and retinopathy, defined as the presence of microaneurysms, hemorrhages, exudates, microvascular abnormalities, or other evidence of diabetic retinopathy by fundus photograph.
  
  
  RESULTS
  All-cause and cardiovascular mortality.
  
  
  METHODS
  Multivariable-adjusted Cox proportional hazards.
  
  
  RESULTS
  Overall, 4.6% of participants had retinopathy and 15% had CKD. Mean age was 56 years, 53% were women, and 81% were non-Hispanic whites. The prevalence of retinopathy in patients with CKD was 11%. We identified 2,634 deaths during 14.5 years' follow-up. In multivariable analyses, compared with individuals with neither CKD nor retinopathy, HRs for all-cause mortality were 1.02 (95% CI, 0.75-1.38), 1.52 (95% CI, 1.35-1.72), and 2.39 (95% CI, 1.77-3.22) for individuals with retinopathy only, those with CKD only, and those with both CKD and retinopathy, respectively. Corresponding HRs for cardiovascular mortality were 0.96 (95% CI, 0.50-1.84), 1.72 (95% CI, 1.47-2.00), and 2.96 (95% CI, 2.11-4.15), respectively. There was a significant synergistic interaction between retinopathy and CKD on all-cause mortality (P=0.04).
  
  
  CONCLUSIONS
  The presence of retinopathy was evaluated only once. Small sample size of some of the subpopulations studied.
  
  
  CONCLUSIONS
  In the presence of CKD, retinopathy is a strong predictor of mortality in this adult population.
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL. Electronic address: aricar2@uic.edu.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Ricardo
authors.affiliation: Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Grunwald
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL.
authors.forename: Sharmila
authors.initials: S
authors.lastname: Parvathaneni
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL.
authors.forename: Sean
authors.initials: S
authors.lastname: Goodin
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL.
authors.forename: Alice
authors.initials: A
authors.lastname: Ching
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL.
authors.forename: James P
authors.initials: JP
authors.lastname: Lash
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058437:Hypertensive Retinopathy / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys / Q000639:trends*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000639:trends*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality*
keywords: Chronic kidney disease (CKD); cardiovascular disease; death; fundus pathology; funduscopy; mortality; renal failure; retinopathy