Retinal arteriolar narrowing and subsequent development of CKD stage 3: The multi-ethnic study of atherosclerosis (MESA)

Background: Microvascular disease is a major pathogenic factor for chronic kidney disease (CKD) in persons with diabetes, but the role of microvascular disease in the development of CKD in the general population is unclear. The aim of this study is to examine whether microvascular disease precedes the development of CKD stage 3 in participants of the Multi-Ethnic Study of Atherosclerosis (MESA). Study Design: Population-based cohort study. Setting & Participants: MESA is a prospective cohort study of adults aged 45-84 years living in 6 US communities; 4,594 adults with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² when they underwent retinal photography (visit 2: in 2002-2004) were examined. Predictor: Retinal microvascular caliber measured from fundus photographs. Outcomes: Incident CKD stage 3 (ie, eGFR <60 mL/min/1.73 m²) at 2 subsequent follow-up examinations (visit 3 in 2004-2005, and visit 4 in 2005-2007) and an annual eGFR decrease >1 mL/min/1.73 m² computed using the CKD Epidemiology Collaboration (CKD-EPI) equation. Results: After a median follow-up of 4.8 years, there were 232 incident CKD stage 3 cases. Overall, retinal microvascular caliber was not associated with incident CKD stage 3. However, in race-stratified analysis, narrower arterioles in whites was associated with a higher risk of developing CKD stage 3 after adjusting for age, sex, blood pressure, diabetes, and other factors (HR, 1.78; 95% CI, 1.01-3.15; P = 0.04, lowest vs highest arteriolar caliber tertile). This association was seen even in whites without hypertension and diabetes (HR, 2.95; 95% CI, 1.10-7.98; P = 0.03). Retinal arteriolar caliber was not associated with incident CKD stage 3 in African Americans, Chinese, or Hispanics. Limitations: Analyses were based on a single eGFR measurement, and retinal microvascular caliber and eGFR measurements were not ascertained concurrently. Conclusion: Microvascular changes as manifest in the eye may contribute to the development of CKD stage 3 in whites.