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Retinal Microvascular Abnormalities and Renal Dysfunction: The Atherosclerosis Risk in Communities Study

Tien Yin Wong^*,, Josef Coresh, Ronald Klein, Paul Muntner^||, David J. Couper^¶, A. Richey Sharrett, Barbara E.K. Klein, Gerardo Heiss^#, Larry D. Hubbard and Bruce B. Duncan^**

*Centre for Eye Research Australia, University of Melbourne, Victoria, Australia; Singapore Eye Research Institute, National University of Singapore, Singapore; Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland; Department of Ophthalmology, University of Wisconsin, Madison, Wisconsin; ^||Department of Epidemiology, Tulane University, New Orleans, Louisiana; Departments of ^¶Biostatistics and ^#Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina; and **Graduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre RS, Brazil

Correspondence to Dr. Tien Yin Wong, Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, Victoria 3002, Australia. Phone: +61-3-9929-8352; Fax: +61-3-9662-3859; E-mail: twong{at}unimelb.edu.au

ABSTRACT. Microvascular disease has been linked with renal dysfunction in patients with diabetes. The aim of this study was to examine the association of retinal microvascular abnormalities to renal dysfunction among participants of the Atherosclerosis Risk in Communities Study, a population-based investigation in four U.S. communities. At the third examination (1993 to 1995), retinal photography was performed and the presence of retinal microvascular abnormalities was documented using a standard grading protocol. Renal dysfunction was defined as an increase in serum creatinine of at least 0.4 mg/dl or a death or hospitalization as a result of chronic kidney disease between the second (1990 to 1992) and fourth (1996 to 1998) examinations. Among 10,056 people who were included in the study, 270 (2.7%) developed renal dysfunction. After controlling for age, gender, race, diabetes, BP, and other risk factors, individuals with retinopathy (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.4 to 2.8), microaneurysms (OR, 2.0; 95% CI, 1.3 to 3.1), retinal hemorrhages (OR, 2.6; 95% CI, 1.6 to 4.0), soft exudates (OR, 2.7; 95% CI, 1.6 to 4.8), and arteriovenous nicking (OR, 1.4; 95% CI, 1.0 to 1.9) were more likely to develop renal dysfunction than individuals without these abnormalities. Retinal microvascular abnormalities are associated with renal dysfunction, suggesting that common systemic microvascular processes may underlie the development of microvascular damage in the eye and kidneys.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673