title: Retinopathy and the risk of cardiovascular disease in patients with chronic kidney disease (from the Chronic Renal Insufficiency Cohort study).
abstract: Patients with chronic kidney disease (CKD) experience other diseases such as cardiovascular disease (CVD) and retinopathy. The purpose of this study was to assess whether retinopathy predicts future CVD events in a subgroup of the participants of the Chronic Renal Insufficiency Cohort (CRIC) study. In this ancillary investigation, 2,605 participants of the CRIC study were invited to participate, and nonmydriatic fundus photographs were obtained in 1,936 subjects. Using standard protocols, presence and severity of retinopathy (diabetic, hypertensive, or other) and vessel diameter caliber were assessed at a central photograph reading center by trained graders masked to study participant's information. Patients with a self-reported history of cardiovascular disease were excluded. Incident CVD events were adjudicated using medical records. Kidney function measurements, traditional and nontraditional risk factors, for CVD were obtained. Presence and severity of retinopathy were associated with increased risk of development of any CVD in this population of CKD patients, and these associations persisted after adjustment for traditional risk factors for CVD. We also found a direct relation between increased venular diameter and risk of development of CVD; however, the relation was not statistically significant after adjustment for traditional risk factors. In conclusion, the presence of retinopathy was associated with future CVD events, suggesting that retinovascular pathology may be indicative of macrovascular disease even after adjustment for renal dysfunction and traditional CVD risk factors. Assessment of retinal morphology may be valuable in assessing risk of CVD in patients with CKD, both clinically and in research settings.
authors.affiliation: Perelman School of Medicine, University of Pennsylvania Philadelphia, Pennsylvania. Electronic address: 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: Maureen
authors.initials: M
authors.lastname: Maguire
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: 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: Perelman School of Medicine, University of Pennsylvania Philadelphia, Pennsylvania.
authors.forename: Emile
authors.initials: E
authors.lastname: Mohler
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 School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Crystal Ann
authors.initials: CA
authors.lastname: Gadegbeku
authors.affiliation: University of Illinois, Chicago, Illinois.
authors.forename: James Phillip
authors.initials: JP
authors.lastname: Lash
authors.affiliation: University of Maryland, Baltimore, Maryland.
authors.forename: Jeffrey Craig
authors.initials: JC
authors.lastname: Fink
authors.affiliation: Maryland Case Western University, Cleveland, Ohio.
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Perelman School of Medicine, University of Pennsylvania Philadelphia, Pennsylvania.
authors.forename: Harold
authors.initials: H
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
authors.affiliation: Perelman School of Medicine, University of Pennsylvania Philadelphia, Pennsylvania.
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology; D012160:Retina / Q000473:pathology*; D012164:Retinal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult