title: Retinopathy and progression of CKD: The CRIC study.
abstract: OBJECTIVE
  Retinal abnormalities may be associated with changes in the renal vasculature. This study assessed the association between retinopathy and progression of kidney disease in participants of the Chronic Renal Insufficiency Cohort (CRIC) study.
  
  
  METHODS
  This was a prospective study in which patients with CKD enrolled in CRIC had nonmydriatic fundus photographs of both eyes. All CRIC participants in six clinical sites in which fundus cameras were deployed were offered participation. Photographs were reviewed at a reading center. The presence and severity of retinopathy and vessel calibers were assessed using standard protocols by graders masked to clinical information. The associations of retinal features with changes in eGFR and the need for RRT (ESRD) were assessed.
  
  
  RESULTS
  Retinal images and renal progression outcomes were obtained from 1852 of the 2605 participants (71.1%) approached. During follow-up (median 2.3 years), 152 participants (8.2%) developed ESRD. Presence and severity of retinopathy at baseline were strongly associated with the risk of subsequent progression to ESRD and reductions in eGFR in unadjusted analyses. For example, participants with retinopathy were 4.4 times (95% confidence interval [95% CI], 3.12 to 6.31) more likely to develop ESRD than those without retinopathy (P<0.001). However, this association was not statistically significant after adjustment for initial eGFR and 24-hour proteinuria. Venular and arteriolar diameter calibers were not associated with ESRD or eGFR decline. The results showed a nonlinear relationship between mean ratio of arteriole/vein calibers and the risk of progression to ESRD; participants within the fourth arteriole/vein ratio quartile were 3.11 times (95% CI, 1.51 to 6.40) more likely to develop ESRD than those in the first quartile (P<0.001).
  
  
  CONCLUSIONS
  The presence and severity of retinopathy were not associated with ESRD and decline in eGFR after taking into account established risk factors.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; juangrun@mail.med.upenn.edu.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Grunwald
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Maxwell
authors.initials: M
authors.lastname: Pistilli
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Gui-Shuang
authors.initials: GS
authors.lastname: Ying
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Daniel
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Maureen G
authors.initials: MG
authors.lastname: Maguire
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Revell
authors.initials: R
authors.lastname: Whittock-Martin
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Candace
authors.initials: C
authors.lastname: Parker Ostroff
authors.affiliation: Kaiser Permanente Northern California, Oakland, California;
authors.forename: Joan C
authors.initials: JC
authors.lastname: Lo
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Raymond R
authors.initials: RR
authors.lastname: Townsend
authors.affiliation: Department of Medicine, Temple University, Philadelphia, Pennsylvania;
authors.forename: Crystal A
authors.initials: CA
authors.lastname: Gadegbeku
authors.affiliation: Division of Nephrology, University of Illinois, Chicago, Illinois;
authors.forename: James P
authors.initials: JP
authors.lastname: Lash
authors.affiliation: Department of Medicine, University of Maryland, Baltimore, Maryland;
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Fink
authors.affiliation: Case Western University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; and.
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
mesh_terms: D000328:Adult; D000368:Aged; D001160:Arterioles / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017711:Nonlinear Dynamics; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D012161:Retinal Artery / Q000473:pathology; D012164:Retinal Diseases / Q000175:diagnosis / Q000453:epidemiology*; D012169:Retinal Vein / Q000473:pathology; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014699:Venules / Q000473:pathology; D055815:Young Adult
keywords: ESRD; chronic renal insufficiency; clinical epidemiology; epidemiology; kidney disease; outcomes