Retinal age, a marker of biological aging, may identify patients at increased risk for end-stage kidney disease (ESKD), investigators suggest.

“The retina has long been considered as a window to the kidney, as common microvascular structures, physiological pathways and pathogenic pathways are shared between the two organs, inextricably linking them in many diseases,” Zhuoting Zhu, MD PhD, of the Centre for Eye Research Australia in Melbourne, and colleagues explained. Common risk factors for retinal and kidney diseases include smoking, diabetes, hypertension, and high cholesterol.

Using a deep learning prediction model, the investigators assessed future ESKD risk among 35,864 adults with retinal fundus images from the UK Biobank study. They calculated the retinal age gap for each individual, defined as the difference between the retinal age predicted by artificial intelligence and chronological age. The mean age of the cohort was 56.8 years, and 93.2% were White.

Continue Reading

After a median 11 years, 115 (0.32%) individuals were diagnosed with ESKD. Each 1-year increase in retinal age gap was independently associated with a 10% increase in ESKD risk, Dr Zhu and colleagues reported in the American Journal of Kidney Diseases. Patients with higher retinal age gaps in the fourth quartile had a significant 2.8-fold increased risk of developing ESKD compared with those in the first quartile.

“The non-invasive, fast and cost-effective features of retinal imaging enable the utility of retinal age gap as a screening and triage tool for ESKD, thus potentially improving the current low compliance rate to kidney disease screening,” Dr Zhu’s team concluded.


Zhang S, Chen R, Wang Y, et al. Association of retinal age gap and risk of kidney failure: A UK Biobank study. Am J Kidney Dis. Published online December 1, 2022. doi:10.1053/j.ajkd.2022.09.018