Researchers already know patients with chronic kidney disease often develop cardiovascular disease and retinopathy. But a new study in the British Journal of Ophthalmology now reports a link between retinopathy progression and a higher rate of cardiovascular events. It also suggests retinal-vascular pathology may be indicative of macrovascular disease, even after adjusting for kidney disease and cardiovascular risk factors.

A US research team assessed 1,051 participants in the Chronic Renal Insufficiency Cohort Study who were invited to have fundus photography taken at two time points separated by approximately 3.5 years.

At a retinal image reading center, masked graders assessed the presence and severity of retinopathy (diabetic, hypertensive or other) and vessel diameter caliber. Participants with a self-reported history of cardiovascular disease were excluded. Physicians evaluated incident cardiovascular events and obtained kidney function and proteinuria measurements along with cardiovascular risk factors at each study visit.

The researchers found 9.8% of participants had worsening retinopathy by two or more steps in the EDTRS retinopathy grading scale. Additionally, they discovered a trend of retinopathy progression that appeared to be tied to an increased risk, more than 2.5 times, of any cardiovascular disease when adjusting for other cardiovascular and chronic kidney disease risk factors. After taking missing data into account, the risk dropped to 1.66.

Assessment of retinal morphology may provide important information when considering cardiovascular disease in patients with chronic kidney disease, the investigators noted.

Grunwald JE, Pistilli M, Ying GS, et al. Progression of retinopathy and incidence of cardiovascular disease: findings from the Chronic Renal Insufficiency Cohort Study. Br J Ophthalmol. June 5, 2020. [Epub ahead of print].