Småbrekke Silje, Brobakk Karl Marius, Rinde Nikoline B, Von Hanno Therese, Bertelsen Geir, Eriksen Bjørn Odvar, Melsom Toralf
Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway.
Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
Kidney Int Rep. 2025 Feb 14;10(5):1384-1392. doi: 10.1016/j.ekir.2025.02.006. eCollection 2025 May.
Age-related decline in glomerular filtration rate (GFR) significantly contributes to chronic kidney disease (CKD). This longitudinal study in a nondiabetic population investigated whether retinal microvascular changes are associated with GFR decline.
The Renal Iohexol Clearance Survey (RENIS) included 1837 participants aged 50 to 62 years without self-reported diabetes, kidney or cardiovascular disease. Baseline retinal vessel measurements and retinopathy were assessed with a Visucam PRONM retinal camera. Iohexol clearance was measured over 1 to 4 visits across an 11-year median follow-up. Linear mixed models and logistic regression were used to analyze associations between retinal vessel measurements, retinopathy, mean annual GFR decline, and accelerated GFR decline.
In multiple adjusted linear mixed models, wider central retinal venular equivalent (CRVE) and wider central retinal arteriolar equivalent (CRAE) were associated with a steeper mean measured GFR (mGFR) decline. For each SD increase, CRVE was associated with an mGFR decline of -0.08 ml/min/yr (95% confidence interval [CI]:-0.15 to -0.02; = 0.012), and CRAE was associated with a decline of -0.09 ml/min/yr (95% CI:-0.15 to -0.02; = 0.007). CRVE, but not CRAE, was associated with accelerated mGFR decline in the model adjusted for age, sex, and height [OR 1.31 (95% CI 1.07-1.61, = 0.008]. No significant associations were observed between retinopathy, microaneurysms, and hemorrhages with annual or accelerated mGFR decline.
CRVE and CRAE, but not retinopathy, retinal microaneurysms, or hemorrhages, were associated with steeper mean mGFR, suggesting that microvascular changes may be one of the underlying mechanisms for age-related GFR loss in a general nondiabetic population.
肾小球滤过率（GFR）随年龄增长而下降是慢性肾脏病（CKD）的重要原因。这项针对非糖尿病人群的纵向研究探讨了视网膜微血管变化是否与GFR下降有关。
肾碘海醇清除率调查（RENIS）纳入了1837名年龄在50至62岁之间、无糖尿病、肾脏或心血管疾病自我报告史的参与者。使用Visucam PRONM视网膜相机评估基线视网膜血管测量和视网膜病变情况。在11年的中位随访期间，进行了1至4次碘海醇清除率测量。采用线性混合模型和逻辑回归分析视网膜血管测量、视网膜病变、平均每年GFR下降和加速GFR下降之间的关联。
在多重校正线性混合模型中，较宽的中央视网膜静脉等效直径（CRVE）和较宽的中央视网膜动脉等效直径（CRAE）与平均测量GFR（mGFR）下降更快有关。每增加1个标准差，CRVE与mGFR下降-0.08 ml/min/年相关（95%置信区间[CI]：-0.15至-0.02；P = 0.012），CRAE与下降-0.09 ml/min/年相关（95%CI：-0.15至-0.02；P = 0.007）。在调整了年龄、性别和身高的模型中，CRVE与加速mGFR下降相关，而CRAE则不然[比值比1.31（95%CI 1.07-1.61，P = 0.008]。未观察到视网膜病变、微动脉瘤和出血与每年或加速的mGFR下降之间存在显著关联。
CRVE和CRAE与更陡峭的平均mGFR下降相关，而非视网膜病变、视网膜微动脉瘤或出血，这表明微血管变化可能是一般非糖尿病人群中与年龄相关的GFR丧失的潜在机制之一。
