Department of Ophthamology, University of Pennsylvania Medical School, Philadelphia, Pennsylvania, USA.
Clin J Am Soc Nephrol. 2010 May;5(5):867-73. doi: 10.2215/CJN.08271109. Epub 2010 Mar 18.
The objective of this study was to describe the prevalence of ocular fundus pathology in the Chronic Renal Insufficiency Cohort (CRIC) study, a multicenter, longitudinal study of individuals with varying stages of chronic kidney disease (CKD).
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this cross-sectional study, 45 degree digital photos of the disc and macula in both eyes were obtained by nonophthalmologic personnel using a nonmydriatic Canon CR-DGI fundus camera in 1936 individuals who participated in the CRIC study. Photographs were assessed in a masked manner by graders and a retinal specialist at a central photograph reading center. The purpose of this review was to inform participants quickly of conditions that warranted a complete eye examination by an ophthalmologist.
Among the 1936 participants who were photographed, 1904 (98%) had assessable photographs in at least one eye. Eye pathologies that required a follow-up examination by an ophthalmologist were identified in 864 (45%) of these 1904 participants. These eye pathologies included, among others, retinopathy (diabetic and/or hypertensive), a finding that was observed in 482 (25%) of these 1904 participants. Three percent (65 participants) of the 1904 participants had serious eye conditions that required urgent follow-up and treatment. Lower estimated GFR and cardiovascular disease were associated with greater eye pathology. Estimated GFR <30 ml/min per 1.73 m(2) was associated with a three times higher risk for retinopathy.
We found a high prevalence of fundus pathology in participants with CKD. This finding supports recommendations for regular complete eye examinations in the CKD population.
本研究旨在描述慢性肾功能不全队列（CRIC）研究中眼部眼底病变的患病率。CRIC 是一项多中心、纵向研究，纳入了不同慢性肾脏病（CKD）分期的个体。
设计、地点、参与者和测量方法：在这项横断面研究中，通过非眼科人员使用非散瞳佳能 CR-DGI 眼底相机对 1936 名 CRIC 研究参与者的双眼视盘和黄斑区进行 45 度数码照相。照片由分级员和视网膜专家在中央照相阅读中心进行盲法评估。本综述的目的是快速告知参与者，有哪些情况需要由眼科医生进行全面的眼部检查。
在 1936 名接受照相的参与者中，有 1904 名（98%）至少有一只眼的照片可评估。在这些 1904 名参与者中，有 864 名（45%）发现需要由眼科医生进行随访检查的眼部病变。这些眼部病变包括糖尿病和/或高血压性视网膜病变等，在这些 1904 名参与者中有 482 名（25%）存在这种病变。在 1904 名参与者中有 3%（65 名）存在需要紧急随访和治疗的严重眼部疾病。估计肾小球滤过率较低和心血管疾病与更多的眼部病变相关。估计肾小球滤过率<30ml/min/1.73m(2)与视网膜病变的风险增加三倍相关。
我们发现 CKD 患者眼底病变的患病率较高。这一发现支持在 CKD 人群中定期进行全面眼部检查的建议。
