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 - Funding Information:
This project was funded by the Medical Research Council UK; grant number MR/K003364/1 (GJM). The Singapore Epidemiology of Eye Diseases (SEED) study was supported by grants from the Singapore Ministry of Health's National Medical Research Council (NMRC) (NMRC/0796/2003, NMRC/STaR/0003/2008, NMRC/1249/2010, and NMRC/OFLCG/001/2017). The Atherosclerosis Risk in Communities study (ARIC) has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, under contracts HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. The authors thank the staff and participants of the ARIC study for their important contributions. The Multiethnic Study of Atherosclerosis (MESA) was supported by contracts N01-HC-95159 through N01-HC-95165 from the NHLBI and NIH Intramural Research award Z01EY000403 from the National Eye Institute, USA. The Cardiovascular Health Study (CHS) was supported by contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grants U01HL080295 and U01HL130114 from the NHLBI, with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). The Blue Mountains Eye Study (BMES) was supported by the Australian National Health & Medical Research Council (NHMRC), in the following project grants: 991407, 974159, 350448, 302068, 211069, 153948, and 457349. WKL contributed to formal analysis and writing (review and editing). EP contributed to writing (original draft—review and editing). CCP, APM, PM, BEK, RK, and TYW contributed to conceptualization and writing (review and editing). RBBMA, EST, CYC, TK, HY, M. Sarnak, M. Shlipak, KM, UM, MAI, CK, AK, and CM contributed to writing (review and editing). CS contributed to conceptualization, supervision, and writing (review and editing). GJM contributed to funding acquisition, conceptualization, supervision, and writing (review and editing). Takahata: Tsuneo Konta, Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine, Yamagata, Japan; Ryo Kawasaki, Department of Public Health, Yamagata University School of Medicine, Yamagata, Japan.
Funding Information:
This project was funded by the Medical Research Council UK; grant number MR/K003364/1 (GJM). The Singapore Epidemiology of Eye Diseases (SEED) study was supported by grants from the Singapore Ministry of Health’s National Medical Research Council (NMRC) (NMRC/0796/2003, NMRC/STaR/0003/2008, NMRC/1249/2010, and NMRC/OFLCG/001/2017). The Atherosclerosis Risk in Communities study (ARIC) has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, under contracts HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I. The authors thank the staff and participants of the ARIC study for their important contributions. The Multiethnic Study of Atherosclerosis (MESA) was supported by contracts N01-HC-95159 through N01-HC-95165 from the NHLBI and NIH Intramural Research award Z01EY000403 from the National Eye Institute , USA. The Cardiovascular Health Study (CHS) was supported by contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grants U01HL080295 and U01HL130114 from the NHLBI, with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). The Blue Mountains Eye Study (BMES) was supported by the Australian National Health & Medical Research Council (NHMRC), in the following project grants: 991407, 974159, 350448, 302068, 211069, 153948, and 457349.
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
UR - http://www.scopus.com/inward/record.url?scp=85100062711&partnerID=8YFLogxK
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 -