视网膜血管直径与估算肾小球滤过率下降的双向关联：比弗大坝 CKD 研究。
Bidirectional association of retinal vessel diameters and estimated GFR decline: the Beaver Dam CKD Study.
机构信息
Department of Community Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
出版信息
Am J Kidney Dis. 2011 May;57(5):682-91. doi: 10.1053/j.ajkd.2010.11.025.
BACKGROUND
Recent cross-sectional studies have reported an association between retinal vessel caliber and chronic kidney disease (CKD), but the direction of the association between these 2 processes is not clear. In a prospective study with multiple measurements of retinal vessel diameters and serum creatinine, we examined whether baseline retinal vessel diameter is associated with future risk of decreased kidney function, or vice versa.
STUDY DESIGN
Population-based cohort study.
SETTING & PARTICIPANTS: 3,199 Wisconsin adults aged 43-84 years who were followed up prospectively for 15 years.
PREDICTOR
Baseline retinal arteriolar and venular diameters for analysis 1 and baseline estimated glomerular filtration rate (eGFR) categories for analysis 2.
OUTCOMES & MEASUREMENTS: For analysis 1, incident CKD, defined as eGFR <60 mL/min/1.73 m(2) accompanied by a 25% decrease in eGFR, during follow-up. For analysis 2, incident retinal arteriolar narrowing, defined as a central retinal arteriolar equivalent measurement <144.0 μm, and incident retinal venular dilation, defined as a central retinal venular equivalent measurement >243.8 μm.
RESULTS
Baseline retinal arteriolar and venular diameters were not associated with 15-year risk of incident CKD. After adjustment for age, sex, diabetes, hypertension, and other confounders, the multivariable HR of incident CKD comparing the narrowest with the widest quartile was 1.15 (95% CI, 0.74-1.80) for retinal arteriolar diameter and 1.05 (95% CI, 0.67-1.67) for retinal venular diameter. Similarly, there was no significant association between eGFR and 15-year risk of incident retinal arteriolar narrowing or retinal venular widening. Compared with eGFR >90 mL/min/1.73 m(2) (referent), the multivariable HR for those with eGFR <45 mL/min/1.73 m(2) was 1.66 (95% CI, 0.93-2.96) for incident retinal arteriolar narrowing and 0.60 (95% CI, 0.17-1.85) for retinal venular widening.
LIMITATIONS
Lack of data for albuminuria and loss to follow-up.
CONCLUSIONS
Retinal vessel diameters and CKD may run together through shared mechanisms, but are not causally related.
背景
最近的横断面研究报告称，视网膜血管口径与慢性肾脏病（CKD）之间存在关联，但这两个过程之间的关联方向尚不清楚。在一项对视网膜血管直径进行多次测量和血清肌酐检测的前瞻性研究中，我们研究了基线视网膜血管直径是否与未来肾功能下降的风险相关，或者反之亦然。
研究设计
基于人群的队列研究。
研究地点和参与者
3199 名年龄在 43-84 岁的威斯康星州成年人，前瞻性随访 15 年。
预测指标
视网膜小动脉和小静脉直径的基线值用于分析 1，以及基线估计肾小球滤过率（eGFR）类别用于分析 2。
结局和测量
对于分析 1，定义为 eGFR <60 mL/min/1.73 m2 并伴有 eGFR 下降 25%的新发 CKD。对于分析 2，定义为视网膜小动脉变窄的事件，定义为中央视网膜小动脉等效值测量值<144.0 μm，以及定义为视网膜小静脉扩张的事件，定义为中央视网膜小静脉等效值测量值>243.8 μm。
结果
基线视网膜小动脉和小静脉直径与 15 年新发 CKD 的风险无关。在调整年龄、性别、糖尿病、高血压和其他混杂因素后，视网膜小动脉直径最窄与最宽四分位间距相比，新发 CKD 的多变量 HR 为 1.15（95%CI，0.74-1.80），视网膜小静脉直径为 1.05（95%CI，0.67-1.67）。同样，eGFR 与 15 年视网膜小动脉变窄或视网膜小静脉变宽的风险之间也没有显著关联。与 eGFR >90 mL/min/1.73 m2（参照）相比，eGFR <45 mL/min/1.73 m2 的患者视网膜小动脉变窄的多变量 HR 为 1.66（95%CI，0.93-2.96），视网膜小静脉扩张的 HR 为 0.60（95%CI，0.17-1.85）。
局限性
缺乏白蛋白尿数据和随访丢失。
结论
视网膜血管直径和 CKD 可能通过共同的机制而同时存在，但它们之间没有因果关系。
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