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

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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
Pages (from-to)1
JournalKidney International
Early online date15 Aug 2020
Publication statusEarly online date - 15 Aug 2020

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Copyright © 2020. Published by Elsevier Inc.


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