A systematic review and participant-level meta-analysis found little association of retinal microvascular caliber and reduced kidney function

Weng Kit Lye, Euan Paterson, Christopher C Patterson, Alexander P Maxwell, Riswana Banu Binte Mohammed Abdul, E Shyong Tai, Ching Yu Cheng, Takamasa Kayama, Hidetoshi Yamashita, Mark Sarnak, Michael Shlipak, Kunihiro Matsushita, Unal Mutlu, Mohammad A Ikram, Caroline Klaver, Annette Kifley, Paul Mitchell, Chelsea Myers, Barbara E Klein, Ronald KleinTien Y Wong, Charumathi Sabanayagam, Gareth J McKay

Research output: Contribution to journalArticle

Abstract

Previously, variation in retinal vascular caliber has been reported in association with chronic kidney disease (CKD) but findings remain inconsistent. To help clarify this we conducted individual participant data meta-analysis and aggregate data meta-analysis on summary estimates to evaluate cross-sectional associations between retinal vascular caliber and CKD. A systematic review was performed using Medline and EMBASE for articles published until October 2018. The aggregate analysis used a two-stage approach combining summary estimates from eleven studies (44,803 patients) while the individual participant analysis used a one-stage approach combining raw data from nine studies (33,222 patients). CKD stages 3-5 was defined as an estimated glomerular filtration rate under 60 mL/min/1.73m2. Retinal arteriolar and venular caliber (central retinal arteriolar and venular equivalent) were assessed from retinal photographs using computer-assisted methods. Logistic regression estimated relative risk of CKD stages 3-5 associated with a 20 μm decrease (approximately one standard deviation) in central retinal arteriolar and venular equivalent. Prevalence of CKD stages 3-5 was 11.2 % of 33,222 and 11.3 % of 44,803 patients in the individual participant and aggregate data analysis, respectively. No significant associations were detected in adjusted analyses between central retinal arteriolar and venular equivalent and CKD stages 3-5 in the aggregate analysis for central retinal arteriolar relative risk (0.98, 95% confidence interval 0.94-1.03); venular equivalent (0.99, 0.95- 1.04) or individual participant central retinal arteriolar (0.99, 0.95-1.04) or venular equivalent (1.01, 0.97-1.05). Thus, meta-analysis provided little evidence to suggest that cross sectional direct measurements of retinal vascular caliber was associated with CKD stages 3-5 in the general population. Hence, meta-analyses of longitudinal studies evaluating the association between retinal parameters and CKD stages 3-5 may be warranted.

Original languageEnglish
JournalKidney International
Early online date15 Aug 2020
DOIs
Publication statusEarly online date - 15 Aug 2020

Bibliographical note

Copyright © 2020. Published by Elsevier Inc.

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    Lye, W. K., Paterson, E., Patterson, C. C., Maxwell, A. P., Binte Mohammed Abdul, R. B., Tai, E. S., Cheng, C. Y., Kayama, T., Yamashita, H., Sarnak, M., Shlipak, M., Matsushita, K., Mutlu, U., Ikram, M. A., Klaver, C., Kifley, A., Mitchell, P., Myers, C., Klein, B. E., ... McKay, G. J. (2020). A systematic review and participant-level meta-analysis found little association of retinal microvascular caliber and reduced kidney function. Kidney International. https://doi.org/10.1016/j.kint.2020.06.033