Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Kaiser Permanente Northern California, Oakland.
JAMA Ophthalmol. 2019 Jul 1;137(7):767-774. doi: 10.1001/jamaophthalmol.2019.1052.
Associations between retinopathy and kidney disease have been previously described. The association between the progression of retinopathy and concurrent progression of chronic kidney disease is unknown.
To assess the association between progression of retinopathy and concurrent progression of chronic kidney disease (CKD) among persons with CKD enrolled in a prospective cohort study.
DESIGN, SETTING, AND PARTICIPANTS: A total of 1936 patients with chronic kidney disease enrolled in the multicenter, prospective Chronic Renal Insufficiency Cohort (CRIC) Study were invited to have 2 nonmydriatic fundus photography sessions separated by a mean (SD) of 3.5 (0.5) years. The study was conducted from May 12, 2006, to June 29, 2011. Data analysis was performed from March 16, 2016, to November 17, 2017.
Fundus photographs obtained at baseline and then at a follow-up at 3.5 years were reviewed by masked graders for presence and severity of retinopathy, and vessel calibers were assessed using standard protocols. The associations of the changes in retinal features with progression of CKD (50% estimated glomerular filtration rate [eGFR] loss or incident end-stage renal disease, and differences in eGFR slope in the same time period) were assessed with univariable and multivariable logistic regression models.
Among 1583 CRIC participants who had baseline fundus photography, had additional follow-up in CRIC, and were at risk for retinopathy progression, 1025 patients (64.8%) had follow-up photography. The odds ratio (OR) for CKD progression associated with worsening of retinopathy in comparison with participants with stable retinopathy was 2.24 (95% CI, 1.28-3.91; P = .005) in univariable analysis among participants with baseline and follow-up photography. In the multivariable analysis, the OR was 1.62 (95% CI, 0.77-3.39; P = .20). The multiple imputation analysis provided similar results.
Progression of retinopathy appears to be associated with progression of CKD on univariable analysis but not on multivariable analysis suggesting that similar risk factors may be affecting the progression of both retinal and chronic kidney disease.
先前已经描述了视网膜病变与肾脏疾病之间的关联。但是，视网膜病变的进展与同时发生的慢性肾脏病（CKD）进展之间的关联尚不清楚。
评估前瞻性队列研究中患有 CKD 的患者中视网膜病变进展与同时发生的慢性肾脏病（CKD）进展之间的关联。
设计、地点和参与者：共邀请了 1936 名患有慢性肾脏病的患者参加多中心、前瞻性慢性肾功能不全队列（CRIC）研究，他们接受了两次非散瞳眼底摄影检查，两次检查的平均（标准差）时间间隔为 3.5（0.5）年。该研究于 2006 年 5 月 12 日至 2011 年 6 月 29 日进行。数据分析于 2016 年 3 月 16 日至 2017 年 11 月 17 日进行。
通过盲法分级对基线和 3.5 年后的眼底照片进行评估，以评估视网膜病变的存在和严重程度，并使用标准方案评估血管直径。使用单变量和多变量逻辑回归模型评估视网膜特征变化与 CKD 进展（肾小球滤过率 [eGFR] 损失 50%或终末期肾脏疾病的发生，以及同一时期 eGFR 斜率的差异）之间的关联。
在 1583 名基线眼底摄影检查且有 CRIC 随访且有视网膜病变进展风险的 CRIC 参与者中，有 1025 名（64.8%）接受了随访摄影。与稳定视网膜病变的患者相比，与视网膜病变恶化相关的 CKD 进展的优势比（OR）在有基线和随访摄影的患者中为 2.24（95%CI，1.28-3.91；P=0.005）。在多变量分析中，OR 为 1.62（95%CI，0.77-3.39；P=0.20）。多重插补分析提供了类似的结果。
视网膜病变的进展似乎与单变量分析中的 CKD 进展相关，但与多变量分析无关，这表明可能有相似的危险因素影响视网膜和慢性肾脏病的进展。
