Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Br J Ophthalmol. 2021 Feb;105(2):246-252. doi: 10.1136/bjophthalmol-2019-315333. Epub 2020 Jun 5.
Chronic kidney disease (CKD) patients often develop cardiovascular disease (CVD) and retinopathy. The purpose of this study was to assess the association between progression of retinopathy and concurrent incidence of CVD events in participants with CKD.
We assessed 1051 out of 1936 participants in the Chronic Renal Insufficiency Cohort Study that were invited to have fundus photographs obtained at two timepoints separated by 3.5 years, on average.
Using standard protocols, presence and severity of retinopathy (diabetic, hypertensive or other) and vessel diameter calibre were assessed at a retinal image reading centre by trained graders masked to study participants' information. Participants with a self-reported history of CVD were excluded. Incident CVD events were physician adjudicated using medical records and standardised criteria. Kidney function and proteinuria measurements along with CVD risk factors were obtained at study visits.
Worsening of retinopathy by two or more steps in the EDTRS retinopathy grading scale was observed in 9.8% of participants, and was associated with increased risk of incidence of any CVD in analysis adjusting for other CVD and CKD risk factors (OR 2.56, 95% CI 1.25 to 5.22, p<0.01). After imputation of missing data, these values were OR=1.66 (0.87 to 3.16), p=0.12.
Progression of retinopathy is associated with higher incidence of CVD events, and retinal-vascular pathology may be indicative of macrovascular disease even after adjustment for kidney diseases and CVD risk factors. Assessment of retinal morphology may provide important information when assessing CVD in patients with CKD.
慢性肾脏病（CKD）患者常并发心血管疾病（CVD）和视网膜病变。本研究旨在评估 CKD 患者视网膜病变进展与同期 CVD 事件发生的相关性。
我们评估了慢性肾功能不全队列研究中的 1936 名参与者中的 1051 名，这些参与者被邀请在平均 3.5 年的时间间隔内两次进行眼底照片拍摄。
使用标准方案，在视网膜图像阅读中心，由经过培训的分级员对视网膜病变（糖尿病性、高血压性或其他）的存在和严重程度以及血管直径进行评估，这些分级员对研究参与者的信息进行了屏蔽。排除有 CVD 病史的参与者。通过医疗记录和标准化标准，由医师对 CVD 事件进行判定。在研究访问时获取肾功能和蛋白尿测量值以及 CVD 危险因素。
EDTRS 视网膜病变分级量表上视网膜病变恶化两级或更多级别的患者占 9.8%，在分析中调整其他 CVD 和 CKD 危险因素后，其发生任何 CVD 的风险增加（OR 2.56，95%CI 1.25 至 5.22，p<0.01）。在对缺失数据进行插补后，这些值为 OR=1.66（0.87 至 3.16），p=0.12。
视网膜病变的进展与 CVD 事件的发生率增加相关，即使在调整了肾脏疾病和 CVD 危险因素后，视网膜血管病理学也可能表明存在大血管疾病。评估视网膜形态可能在评估 CKD 患者的 CVD 时提供重要信息。
