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American Journal of Epidemiology Advance Access published online on December 16, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn367
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Original Contribution

Retinal Microvascular Caliber and Chronic Kidney Disease in an Asian Population

Charumathi Sabanayagam, Anoop Shankar, David Koh, Kee Seng Chia, Seang Mei Saw, Su Chi Lim, E. Shyong Tai and Tien Yin Wong

Correspondence to Dr. Anoop Shankar, Department of Community Medicine, West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, 1 Medical Center Drive, P.O. Box 9190, Morgantown, WV 26505-9190 (e-mail: ashankar{at}hsc.wvu.edu).

Received for publication March 24, 2008. Accepted for publication October 16, 2008.

Retinal arteriolar narrowing is a marker of microvascular damage from elevated blood pressure. Between August 2004 and June 2006, the authors examined the association between retinal vascular diameter and chronic kidney disease in a population-based cohort of 3,280 community-dwelling adults of Malay ethnicity aged 40–80 years living in Singapore. Chronic kidney disease was defined as 1) an estimated glomerular filtration rate (eGFR) of <60 mL/minute/1.73 m2 from serum creatinine or 2) the presence of micro/macroalbuminuria defined as urinary albumin:creatinine ratios of ≥17 mg/g for men and ≥25 mg/g for women. Retinal arteriolar and venular diameters were measured and summarized as central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE). Individuals with reduced CRAE were more likely to have chronic kidney disease than those with increased CRAE. After controlling for age, gender, education, smoking, diabetes, hypertension, body mass index, and total and high density lipoprotein cholesterol, the authors found the odds ratio comparing the smallest with the largest CRAE quartile to be 1.42 (95% confidence interval: 1.03, 1.96; Ptrend = 0.02) for eGFR of <60 mL/minute/1.73 m2 and 1.80 (95% confidence interval: 1.11, 2.91; Ptrend = 0.01) for micro/macroalbuminuria. Retinopathy was also found to be positively associated with both eGFR and micro/macroalbuminuria. Retinal venular diameter was not associated with chronic kidney disease. These data suggest that retinal arteriolar narrowing is associated with chronic kidney disease, independent of diabetes and hypertension.

albuminuria; arterioles; glomerular filtration rate; kidney diseases; retina; Singapore

Abbreviations: CI, confidence interval; CRAE, central retinal arteriolar equivalent; CRVE, central retinal venular equivalent; eGFR, estimated glomerular filtration rate; ETDRS, Early Treatment for Diabetic Retinopathy Study; HbA1C, glycosylated hemoglobin


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