TY - JOUR
T1 - A systematic review and participant-level meta-analysis found little association of retinal microvascular caliber with reduced kidney function
AU - Lye, Weng Kit
AU - Paterson, Euan
AU - Patterson, Christopher C.
AU - Maxwell, Alexander P.
AU - Binte Mohammed Abdul, Riswana Banu
AU - Tai, E. Shyong
AU - Cheng, Ching Yu
AU - Kayama, Takamasa
AU - Yamashita, Hidetoshi
AU - Sarnak, Mark
AU - Shlipak, Michael
AU - Matsushita, Kunihiro
AU - Mutlu, Unal
AU - Ikram, Mohammad A.
AU - Klaver, Caroline
AU - Kifley, Annette
AU - Mitchell, Paul
AU - Myers, Chelsea
AU - Klein, Barbara E.
AU - Klein, Ronald
AU - Wong, Tien Y.
AU - Sabanayagam, Charumathi
AU - McKay, Gareth J.
N1 - Publisher Copyright:
© 2020 International Society of Nephrology
PY - 2021/3
Y1 - 2021/3
N2 - Previously, variation in retinal vascular caliber has been reported in association with chronic kidney disease (CKD) but findings remain inconsistent. To help clarify this we conducted individual participant data meta-analysis and aggregate data meta-analysis on summary estimates to evaluate cross-sectional associations between retinal vascular caliber and CKD. A systematic review was performed using Medline and EMBASE for articles published until October 2018. The aggregate analysis used a two-stage approach combining summary estimates from eleven studies (44,803 patients) while the individual participant analysis used a one-stage approach combining raw data from nine studies (33,222 patients). CKD stages 3-5 was defined as an estimated glomerular filtration rate under 60 mL/min/1.73m2. Retinal arteriolar and venular caliber (central retinal arteriolar and venular equivalent) were assessed from retinal photographs using computer-assisted methods. Logistic regression estimated relative risk of CKD stages 3-5 associated with a 20 μm decrease (approximately one standard deviation) in central retinal arteriolar and venular equivalent. Prevalence of CKD stages 3-5 was 11.2% of 33,222 and 11.3% of 44,803 patients in the individual participant and aggregate data analysis, respectively. No significant associations were detected in adjusted analyses between central retinal arteriolar and venular equivalent and CKD stages 3-5 in the aggregate analysis for central retinal arteriolar relative risk (0.98, 95% confidence interval 0.94-1.03); venular equivalent (0.99, 0.95-1.04) or individual participant central retinal arteriolar (0.99, 0.95-1.04) or venular equivalent (1.01, 0.97-1.05). Thus, meta-analysis provided little evidence to suggest that cross sectional direct measurements of retinal vascular caliber was associated with CKD stages 3-5 in the general population. Hence, meta-analyses of longitudinal studies evaluating the association between retinal parameters and CKD stages 3-5 may be warranted.
AB - Previously, variation in retinal vascular caliber has been reported in association with chronic kidney disease (CKD) but findings remain inconsistent. To help clarify this we conducted individual participant data meta-analysis and aggregate data meta-analysis on summary estimates to evaluate cross-sectional associations between retinal vascular caliber and CKD. A systematic review was performed using Medline and EMBASE for articles published until October 2018. The aggregate analysis used a two-stage approach combining summary estimates from eleven studies (44,803 patients) while the individual participant analysis used a one-stage approach combining raw data from nine studies (33,222 patients). CKD stages 3-5 was defined as an estimated glomerular filtration rate under 60 mL/min/1.73m2. Retinal arteriolar and venular caliber (central retinal arteriolar and venular equivalent) were assessed from retinal photographs using computer-assisted methods. Logistic regression estimated relative risk of CKD stages 3-5 associated with a 20 μm decrease (approximately one standard deviation) in central retinal arteriolar and venular equivalent. Prevalence of CKD stages 3-5 was 11.2% of 33,222 and 11.3% of 44,803 patients in the individual participant and aggregate data analysis, respectively. No significant associations were detected in adjusted analyses between central retinal arteriolar and venular equivalent and CKD stages 3-5 in the aggregate analysis for central retinal arteriolar relative risk (0.98, 95% confidence interval 0.94-1.03); venular equivalent (0.99, 0.95-1.04) or individual participant central retinal arteriolar (0.99, 0.95-1.04) or venular equivalent (1.01, 0.97-1.05). Thus, meta-analysis provided little evidence to suggest that cross sectional direct measurements of retinal vascular caliber was associated with CKD stages 3-5 in the general population. Hence, meta-analyses of longitudinal studies evaluating the association between retinal parameters and CKD stages 3-5 may be warranted.
KW - biomarker
KW - caliber
KW - chronic kidney disease
KW - microvasculature
KW - retina
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UR - http://www.scopus.com/inward/citedby.url?scp=85100062711&partnerID=8YFLogxK
U2 - 10.1016/j.kint.2020.06.033
DO - 10.1016/j.kint.2020.06.033
M3 - Article
C2 - 32810524
AN - SCOPUS:85100062711
SN - 0085-2538
VL - 99
SP - 696
EP - 706
JO - Kidney international
JF - Kidney international
IS - 3
ER -