Associations between retinal microvascular abnormalities and declining renal function in the elderly population: The Cardiovascular Health Study
Associations between retinal microvascular abnormalities and declining renal function in the elderly population: The Cardiovascular Health Study
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DOI：
10.1053/j.ajkd.2005.05.005
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发表时间：
2005-08-01
影响因子：
13.2
通讯作者：
Hansen, KJ
中科院分区：
文献类型：
--
作者：
Edwards, MS;Wilson, DB;Hansen, KJ
背景：肾脏微血管异常是慢性肾脏疾病或肾功能衰竭患者常见的组织病理学表现。这些异常可能是持续性全身微血管损伤的表现之一。我们假设，视网膜微血管异常，当存在时，将与老年人进行性肾功能不全。研究方法：心血管健康研究（CHS）是一项于1989年启动的前瞻性、多中心、队列研究，旨在检查美国老年人的心血管危险因素、发病率和死亡率。作为辅助研究的一部分，CHS参与者在1997年和1998年进行了视网膜摄影。视网膜微血管异常进行了评估和分级使用标准化的措施。视网膜微血管异常定义为视网膜病变（硬和软渗出物、血管瘤或微动脉瘤）和/或视网膜小动脉异常（动静脉切口、局灶性小动脉狭窄或最低四分位数小动脉-小静脉比）。使用回归模型检查了这些异常与观察到的血清肌酸酐水平的4年变化和研究第5至9年（包括1994年至2001年）估计的肾小球滤过率（eGFRs）之间的关系。结果：共有1,394名CHS参与者有视网膜和血清肌酐数据。在对年龄、种族、性别、体重、糖尿病、高血压、血管紧张素转换酶抑制剂使用和蛋白尿进行调整后，在4年的研究期间，与没有视网膜病变的受试者相比，患有视网膜病变的受试者显示血清肌酐水平显著升高，eGFR显著下降（分别为+0.24 mg/dL [+21 μ mol/L]对比-0.21 mg/dL [-19 μ mol/L]和-0.48 mL/min/1.73 m（2）[-0.01 mL/s/1.73 m（2）]对比+1.74 mL/min/1.73 m（2）[+0.03 mL/s/1.73 m（2）]）。患有视网膜病变的参与者也更有可能观察到肾功能的显著恶化，定义为0.3 mg/dL（27 μ mol/L）血清肌酐水平升高或eGFR下降20%或以上（比值比，3.20; 95%置信区间，1.58至6.50;比值比，2.84; 95%置信区间，1.56至5.16）。这些关联在对患有糖尿病和不患有糖尿病的患者进行单独分层分析时仍然存在。视网膜小动脉异常的存在与肾功能恶化无关。结论：视网膜微血管异常（定义为视网膜病变）与肾功能恶化显著相关。观察到的结果与任何相关的糖尿病或高血压的影响无关。这些发现表明，全身性微血管疾病可能与老年人群中进行性肾功能不全有关。
Background: Microvascular abnormalities in the kidney are common histopathologic findings in individuals with chronic kidney disease or renal failure. These abnormalities may represent one manifestation of ongoing systemic microvascular damage. We hypothesized that retinal microvascular abnormalities, when present, would be associated with progressive renal dysfunction in elderly individuals. Methods: The Cardiovascular Health Study (CHS) is a prospective, multicenter, cohort study initiated in 1989 designed to examine cardiovascular risk factors, morbidity, and mortality in elderly Americans. As part of an ancillary study, CHS participants underwent retinal photography in 1997 and 1998. Retinal microvascular abnormalities were assessed and graded by using standardized measures. Retinal microvascular abnormalities were defined as retinopathy (hard and soft exudates, hemorrhages, or microaneurysms) and/or retinal arteriolar abnormalities (arteriovenous nicking, focal arteriolar narrowing, or lowest quartile arteriole-venule ratio). Associations between these abnormalities and observed 4-year changes in serum creatinine levels and estimated glomerular filtration rates (eGFRs) from study years 5 to 9 (encompassing years 1994 to 2001) were examined by using regression modeling. Results: A total of 1,394 CHS participants had retinal and serum creatinine data. After adjustments for age, race, sex, weight, diabetes, hypertension, angiotensin-converting enzyme inhibitor use, and proteinuria, participants with retinopathy showed a significant increase in serum creatinine level and decline in eGFR compared with those without retinopathy during the 4-year study period (+0.24 mg/dL [+21 mu mol/L] versus -0.21 mg/dL [-19 mu mol/L] and -0.48 mL/min/1.73 m(2) [-0.01 mL/s/1.73 m(2)] versus +1.74 mL/min/1.73 m(2) [+0.03 mL/s/1.73 m(2)], respectively). Participants with retinopathy also were significantly more likely to have an observed significant deterioration in renal function, defined as a 0.3-mg/dL (27-mu mol/L) increase in serum creatinine level or 20% or greater decline in eGFR (odds ratio, 3.20; 95% confidence interval, 1.58 to 6.50; and odds ratio, 2.84; 95% confidence interval, 1.56 to 5.16, respectively). These associations remained in separate stratified analyses of patients with and without diabetes. The presence of retinal arteriolar abnormalities was not associated with deteriorating renal function. Conclusion: Retinal microvascular abnormalities defined as retinopathy were significantly associated with renal function deterioration. The observed findings were independent of effects of any associated diabetes or hypertension. These findings suggest that systemic microvascular disease may be associated with progressive renal dysfunction in the elderly population.