Association of reduced inner retinal thicknesses with Chronic Kidney Disease

Euan N Paterson, Meera L Ravindran, Kayleigh Griffiths, Claire A Le Velly, Chris C Cardwell, Rachel V McCarter, Patrick Nicol, Jay K Chhablani, Mohammed Abdul Rasheed, Kiran Kumar Vupparaboina, Thomas J MacGillivray, Mark Harbinson, Alexander P Maxwell, Ruth E Hogg, Gareth J McKay

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Abstract

Background: Tissue derived biomarkers may offer utility as indicators of accumulated damage. Reduced thickness of retinal neuronal tissue and the vascular choroid have previously been associated with vascular damage and diabetes. We evaluated associations between retinal thickness, retinal microvascular and choroidal measures, and renal function in a population with a high burden of comorbidity. Methods: Participants were recruited from nuclear cardiology or renal medicine clinics. Retinal and choroidal thickness were measured from spectral-domain optical coherence tomograms. Retinal microvascular parameters were assessed from digital fundus photographs using a semi-automated software package. Main Outcome Measure: Chronic kidney disease (CKD) categorised as: CKD stages 1-2, eGFR ≥ 60 ml/min/1.73m2; CKD stage 3, eGFR 30-59 ml/min/1.73m2, and CKD stages 4-5, eGFR ≤ 29 ml/min/1.73m2. Results: Participants (n=241) had a mean age of 65 years and a mean eGFR of 66.9 ml/min/1.73m2. Thirty–nine per cent of the cohort had diabetes and 27% were using diuretics. Thinning of the inner retina and changes to its microvascular blood supply were associated with lower eGFR and CKD stages 4 and 5, while no associations were found between the outer retinal layers or their choroidal blood supply and CKD of any stage. These associations remained following adjustment for age, mean arterial blood pressure, diabetes status, low-density lipoprotein, body mass index, and sex. Conclusions: Inner retinal thinning and retinal microvascular variation is associated with advanced CKD (stages 4 & 5) independent of important confounding factors, but not with earlier stage CKD (stage 3) and, therefore, its utility as a biomarker for early CKD is not supported in this study.
Original languageEnglish
Pages (from-to)37
JournalBMC Nephrology
Volume21
Issue number1
DOIs
Publication statusPublished - 31 Jan 2020

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Chronic Renal Insufficiency
Blood Vessels
Arterial Pressure
Biomarkers
Kidney
Choroid
Cardiology
LDL Lipoproteins
Diuretics
Retina
Comorbidity
Body Mass Index
Software
Medicine
Outcome Assessment (Health Care)
Population

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Paterson, Euan N ; Ravindran, Meera L ; Griffiths, Kayleigh ; Le Velly, Claire A ; Cardwell, Chris C ; McCarter, Rachel V ; Nicol, Patrick ; Chhablani, Jay K ; Rasheed, Mohammed Abdul ; Vupparaboina, Kiran Kumar ; MacGillivray, Thomas J ; Harbinson, Mark ; Maxwell, Alexander P ; Hogg, Ruth E ; McKay, Gareth J. / Association of reduced inner retinal thicknesses with Chronic Kidney Disease. In: BMC Nephrology. 2020 ; Vol. 21, No. 1. pp. 37.
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abstract = "Background: Tissue derived biomarkers may offer utility as indicators of accumulated damage. Reduced thickness of retinal neuronal tissue and the vascular choroid have previously been associated with vascular damage and diabetes. We evaluated associations between retinal thickness, retinal microvascular and choroidal measures, and renal function in a population with a high burden of comorbidity. Methods: Participants were recruited from nuclear cardiology or renal medicine clinics. Retinal and choroidal thickness were measured from spectral-domain optical coherence tomograms. Retinal microvascular parameters were assessed from digital fundus photographs using a semi-automated software package. Main Outcome Measure: Chronic kidney disease (CKD) categorised as: CKD stages 1-2, eGFR ≥ 60 ml/min/1.73m2; CKD stage 3, eGFR 30-59 ml/min/1.73m2, and CKD stages 4-5, eGFR ≤ 29 ml/min/1.73m2. Results: Participants (n=241) had a mean age of 65 years and a mean eGFR of 66.9 ml/min/1.73m2. Thirty–nine per cent of the cohort had diabetes and 27{\%} were using diuretics. Thinning of the inner retina and changes to its microvascular blood supply were associated with lower eGFR and CKD stages 4 and 5, while no associations were found between the outer retinal layers or their choroidal blood supply and CKD of any stage. These associations remained following adjustment for age, mean arterial blood pressure, diabetes status, low-density lipoprotein, body mass index, and sex. Conclusions: Inner retinal thinning and retinal microvascular variation is associated with advanced CKD (stages 4 & 5) independent of important confounding factors, but not with earlier stage CKD (stage 3) and, therefore, its utility as a biomarker for early CKD is not supported in this study.",
author = "Paterson, {Euan N} and Ravindran, {Meera L} and Kayleigh Griffiths and {Le Velly}, {Claire A} and Cardwell, {Chris C} and McCarter, {Rachel V} and Patrick Nicol and Chhablani, {Jay K} and Rasheed, {Mohammed Abdul} and Vupparaboina, {Kiran Kumar} and MacGillivray, {Thomas J} and Mark Harbinson and Maxwell, {Alexander P} and Hogg, {Ruth E} and McKay, {Gareth J}",
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Paterson, EN, Ravindran, ML, Griffiths, K, Le Velly, CA, Cardwell, CC, McCarter, RV, Nicol, P, Chhablani, JK, Rasheed, MA, Vupparaboina, KK, MacGillivray, TJ, Harbinson, M, Maxwell, AP, Hogg, RE & McKay, GJ 2020, 'Association of reduced inner retinal thicknesses with Chronic Kidney Disease', BMC Nephrology, vol. 21, no. 1, pp. 37. https://doi.org/10.1186/s12882-019-1679-1

Association of reduced inner retinal thicknesses with Chronic Kidney Disease. / Paterson, Euan N; Ravindran, Meera L; Griffiths, Kayleigh; Le Velly, Claire A; Cardwell, Chris C; McCarter, Rachel V; Nicol, Patrick; Chhablani, Jay K; Rasheed, Mohammed Abdul; Vupparaboina, Kiran Kumar; MacGillivray, Thomas J; Harbinson, Mark; Maxwell, Alexander P; Hogg, Ruth E; McKay, Gareth J.

In: BMC Nephrology, Vol. 21, No. 1, 31.01.2020, p. 37.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of reduced inner retinal thicknesses with Chronic Kidney Disease

AU - Paterson, Euan N

AU - Ravindran, Meera L

AU - Griffiths, Kayleigh

AU - Le Velly, Claire A

AU - Cardwell, Chris C

AU - McCarter, Rachel V

AU - Nicol, Patrick

AU - Chhablani, Jay K

AU - Rasheed, Mohammed Abdul

AU - Vupparaboina, Kiran Kumar

AU - MacGillivray, Thomas J

AU - Harbinson, Mark

AU - Maxwell, Alexander P

AU - Hogg, Ruth E

AU - McKay, Gareth J

PY - 2020/1/31

Y1 - 2020/1/31

N2 - Background: Tissue derived biomarkers may offer utility as indicators of accumulated damage. Reduced thickness of retinal neuronal tissue and the vascular choroid have previously been associated with vascular damage and diabetes. We evaluated associations between retinal thickness, retinal microvascular and choroidal measures, and renal function in a population with a high burden of comorbidity. Methods: Participants were recruited from nuclear cardiology or renal medicine clinics. Retinal and choroidal thickness were measured from spectral-domain optical coherence tomograms. Retinal microvascular parameters were assessed from digital fundus photographs using a semi-automated software package. Main Outcome Measure: Chronic kidney disease (CKD) categorised as: CKD stages 1-2, eGFR ≥ 60 ml/min/1.73m2; CKD stage 3, eGFR 30-59 ml/min/1.73m2, and CKD stages 4-5, eGFR ≤ 29 ml/min/1.73m2. Results: Participants (n=241) had a mean age of 65 years and a mean eGFR of 66.9 ml/min/1.73m2. Thirty–nine per cent of the cohort had diabetes and 27% were using diuretics. Thinning of the inner retina and changes to its microvascular blood supply were associated with lower eGFR and CKD stages 4 and 5, while no associations were found between the outer retinal layers or their choroidal blood supply and CKD of any stage. These associations remained following adjustment for age, mean arterial blood pressure, diabetes status, low-density lipoprotein, body mass index, and sex. Conclusions: Inner retinal thinning and retinal microvascular variation is associated with advanced CKD (stages 4 & 5) independent of important confounding factors, but not with earlier stage CKD (stage 3) and, therefore, its utility as a biomarker for early CKD is not supported in this study.

AB - Background: Tissue derived biomarkers may offer utility as indicators of accumulated damage. Reduced thickness of retinal neuronal tissue and the vascular choroid have previously been associated with vascular damage and diabetes. We evaluated associations between retinal thickness, retinal microvascular and choroidal measures, and renal function in a population with a high burden of comorbidity. Methods: Participants were recruited from nuclear cardiology or renal medicine clinics. Retinal and choroidal thickness were measured from spectral-domain optical coherence tomograms. Retinal microvascular parameters were assessed from digital fundus photographs using a semi-automated software package. Main Outcome Measure: Chronic kidney disease (CKD) categorised as: CKD stages 1-2, eGFR ≥ 60 ml/min/1.73m2; CKD stage 3, eGFR 30-59 ml/min/1.73m2, and CKD stages 4-5, eGFR ≤ 29 ml/min/1.73m2. Results: Participants (n=241) had a mean age of 65 years and a mean eGFR of 66.9 ml/min/1.73m2. Thirty–nine per cent of the cohort had diabetes and 27% were using diuretics. Thinning of the inner retina and changes to its microvascular blood supply were associated with lower eGFR and CKD stages 4 and 5, while no associations were found between the outer retinal layers or their choroidal blood supply and CKD of any stage. These associations remained following adjustment for age, mean arterial blood pressure, diabetes status, low-density lipoprotein, body mass index, and sex. Conclusions: Inner retinal thinning and retinal microvascular variation is associated with advanced CKD (stages 4 & 5) independent of important confounding factors, but not with earlier stage CKD (stage 3) and, therefore, its utility as a biomarker for early CKD is not supported in this study.

U2 - 10.1186/s12882-019-1679-1

DO - 10.1186/s12882-019-1679-1

M3 - Article

C2 - 32005180

VL - 21

SP - 37

JO - BMC Nephrology

JF - BMC Nephrology

SN - 1471-2369

IS - 1

ER -