Association between Progression of Retinopathy and Concurrent Progression of Kidney Disease: Findings from the Chronic Renal Insufficiency Cohort (CRIC) Study

the Chronic Renal Insufficiency Cohort Study Investigators

Research output: Contribution to journalArticle

Abstract

Importance: 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. Objective: 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. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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.

Original languageEnglish (US)
Pages (from-to)767-774
Number of pages8
JournalJAMA ophthalmology
Volume137
Issue number7
DOIs
StatePublished - Jul 2019

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Kidney Diseases
Chronic Renal Insufficiency
Cohort Studies
Photography
Glomerular Filtration Rate
Logistic Models
Odds Ratio
Chronic Kidney Failure
Disease Progression
Outcome Assessment (Health Care)
Prospective Studies

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Association between Progression of Retinopathy and Concurrent Progression of Kidney Disease : Findings from the Chronic Renal Insufficiency Cohort (CRIC) Study. / the Chronic Renal Insufficiency Cohort Study Investigators.

In: JAMA ophthalmology, Vol. 137, No. 7, 07.2019, p. 767-774.

Research output: Contribution to journalArticle

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title = "Association between Progression of Retinopathy and Concurrent Progression of Kidney Disease: Findings from the Chronic Renal Insufficiency Cohort (CRIC) Study",
abstract = "Importance: 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. Objective: 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. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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.",
author = "{the Chronic Renal Insufficiency Cohort Study Investigators} and Grunwald, {Juan E.} and Maxwell Pistilli and Ying, {Gui Shuang} and Ebenezer Daniel and Maureen Maguire and Dawei Xie and Jason Roy and Revell Whittock-Martin and {Parker Ostroff}, Candace and Lo, {Joan C.} and Townsend, {Raymond R.} and Gadegbeku, {Crystal A.} and Lash, {James P.} and Fink, {Jeffrey C.} and Mahboob Rahman and Feldman, {Harold I.} and Kusek, {John W.} and Appel, {Lawrence J.} and Go, {Alan S.} and Jiang He and Akinlolu Ojo",
year = "2019",
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doi = "10.1001/jamaophthalmol.2019.1052",
language = "English (US)",
volume = "137",
pages = "767--774",
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T1 - Association between Progression of Retinopathy and Concurrent Progression of Kidney Disease

T2 - Findings from the Chronic Renal Insufficiency Cohort (CRIC) Study

AU - the Chronic Renal Insufficiency Cohort Study Investigators

AU - Grunwald, Juan E.

AU - Pistilli, Maxwell

AU - Ying, Gui Shuang

AU - Daniel, Ebenezer

AU - Maguire, Maureen

AU - Xie, Dawei

AU - Roy, Jason

AU - Whittock-Martin, Revell

AU - Parker Ostroff, Candace

AU - Lo, Joan C.

AU - Townsend, Raymond R.

AU - Gadegbeku, Crystal A.

AU - Lash, James P.

AU - Fink, Jeffrey C.

AU - Rahman, Mahboob

AU - Feldman, Harold I.

AU - Kusek, John W.

AU - Appel, Lawrence J.

AU - Go, Alan S.

AU - He, Jiang

AU - Ojo, Akinlolu

PY - 2019/7

Y1 - 2019/7

N2 - Importance: 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. Objective: 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. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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.

AB - Importance: 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. Objective: 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. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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.

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