Retinal Microvascular Endothelial Function is Impaired in Subjects With Chronic Kidney Disease
Section snippets
Background
Endothelial dysfunction is a sentinel precursor to atherosclerosis and is implicated in the common coexistence between cardiovascular disease (CVD) and chronic kidney disease (CKD). We examined whether retinal microvascular endothelial dysfunction is present in subjects with CKD and further predictive of long-term CKD progression.
Methods
In a single centre prospective observational study, 253 subjects with coronary artery disease and CVD risk factors underwent dynamic retinal vessel analysis. Microvascular dysfunction was quantified by measuring retinal arteriolar and venular dilatation in response to flicker light stimulation. Serial assessment of renal function was performed over a median period of 9.4 years.
Results
Flicker light-induced retinal arteriolar dilatation (FI-RAD) was impaired in subjects with baseline eGFR <90 mL/min/1.73 m2, compared to those with normal renal function (eGFR ≥ 90 mL/min/1.73 m2) (1.0% [0.4-2.1] vs. 2.0% [0.8-3.6]; p < 0.01). In patients with normal renal function, a gradient was observed, where subjects with the lowest FI-RAD responses exhibited the greatest annual decline in eGFR. In uni- and multivariable analysis (baseline eGFR ≥ 90 mL/min/1.73 m2), a 1% decrease in FI-RAD
Conclusions
Endothelial dysfunction is an early pathological process in the course of CKD. Dynamic retinal vessel analysis may serve as a novel tool in stratifying patients at risk of renal impairment.