Retinopathy in CKD Patients Predicts Higher Death Risk

Study reveals a greater than twofold increased risk of all-cause and cardiovascular mortality.
Study reveals a greater than twofold increased risk of all-cause and cardiovascular mortality.

Retinopathy in patients with chronic kidney disease (CKD) is associated with an increased risk of death, according to researchers.

In a study of 7,640 adult participants in the National Health and Nutrition Examination Survey (1988-1994), Ana C. Ricardo, MD, MPH, of the University of Illinois at Chicago, and colleagues found that individuals with both CKD and retinopathy had a significant 2.4 times increased risk of all-cause mortality after adjusting for confounders when compared with those who had neither condition.

Retinopathy in the presence of albuminuria, but not low estimated glomerular filtration rate (eGFR), was associated with a significant 4.5 times and 2.6 times increased risk of all-cause and cardiovascular mortality, respectively, the researchers reported online ahead of print in the American Journal of Kidney Diseases.

Patients with CKD but not retinopathy had a 52% increased risk of all-cause mortality and 72% increased risk of cardiovascular mortality. Retinopathy in the absence of CKD was not associated with either all-cause or cardiovascular mortality.

“Mechanisms underlying these associations are not known,” the authors wrote, “but potential explanations include microvascular damage associated with aging, hypertension, atherosclerosis, and other vascular and endothelial changes that might be present in the retina and other vascular beds such as the heart, brain, and kidneys.”

The investigators concluded: “These findings suggest that future work is needed to evaluate retinopathy screening in CKD as a noninvasive tool for assessment of cardiovascular risk in this population,” the investigators concluded.

The study found that 15% of the study population had CKD—defined as an eGFR below 60 mL/min/1.73 m2 or albuminuria (urine protein-creatinine ratio of 30 mg/g or higher)—and 4.6% had retinopathy. The prevalence of retinopathy among participants with CKD was 11%. The researchers identified 2,634 deaths during a follow-up of 14.5 years.

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