PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 16112039

Associations between retinal microvascular abnormalities and declining renal function in the elderly population: the Cardiovascular Health Study.

Matthew S Edwards·David B Wilson·Timothy E Craven·Jeanette Stafford·Linda F Fried·Tien Y Wong·Ronald Klein·Gregory L Burke·Kimberley J Hansen
View original source ↗Export metadata ↓

Abstract

BACKGROUND: Microvascular abnormalities in the kidney are common histopathologic findings in individuals with chronic kidney disease or renal failure. These abnormalities may represent one manifestation of ongoing systemic microvascular damage. We hypothesized that retinal microvascular abnormalities, when present, would be associated with progressive renal dysfunction in elderly individuals. METHODS: The Cardiovascular Health Study (CHS) is a prospective, multicenter, cohort study initiated in 1989 designed to examine cardiovascular risk factors, morbidity, and mortality in elderly Americans. As part of an ancillary study, CHS participants underwent retinal photography in 1997 and 1998. Retinal microvascular abnormalities were assessed and graded by using standardized measures. Retinal microvascular abnormalities were defined as retinopathy (hard and soft exudates, hemorrhages, or microaneurysms) and/or retinal arteriolar abnormalities (arteriovenous nicking, focal arteriolar narrowing, or lowest quartile arteriole-venule ratio). Associations between these abnormalities and observed 4-year changes in serum creatinine levels and estimated glomerular filtration rates (eGFRs) from study years 5 to 9 (encompassing years 1994 to 2001) were examined by using regression modeling. RESULTS: A total of 1,394 CHS participants had retinal and serum creatinine data. After adjustments for age, race, sex, weight, diabetes, hypertension, angiotensin-converting enzyme inhibitor use, and proteinuria, participants with retinopathy showed a significant increase in serum creatinine level and decline in eGFR compared with those without retinopathy during the 4-year study period (+0.24 mg/dL [+21 micromol/L] versus -0.21 mg/dL [-19 micromol/L] and -0.48 mL/min/1.73 m2 [-0.01 mL/s/1.73 m2] versus +1.74 mL/min/1.73 m2 [+0.03 mL/s/1.73 m2], respectively). Participants with retinopathy also were significantly more likely to have an observed significant deterioration in renal function, defined as a 0.3-mg/dL (27-micromol/L) increase in serum creatinine level or 20% or greater decline in eGFR (odds ratio, 3.20; 95% confidence interval, 1.58 to 6.50; and odds ratio, 2.84; 95% confidence interval, 1.56 to 5.16, respectively). These associations remained in separate stratified analyses of patients with and without diabetes. The presence of retinal arteriolar abnormalities was not associated with deteriorating renal function. CONCLUSION: Retinal microvascular abnormalities defined as retinopathy were significantly associated with renal function deterioration. The observed findings were independent of effects of any associated diabetes or hypertension. These findings suggest that systemic microvascular disease may be associated with progressive renal dysfunction in the elderly population.

Explore related subjects

Black or African AmericanAgedAged, 80 and overAgingAntihypertensive AgentsCapillariesCohort StudiesComorbidityCreatinineDiabetes MellitusDisease ProgressionFemaleGlomerular Filtration RateHumansHypertensionKidneyMalePhotographyProspective StudiesProteinuriaRetinaRetinal DiseasesRetinal VesselsWhite PeopleComparative StudyJournal ArticleMulticenter StudyResearch Support, N.I.H., ExtramuralResearch Support, U.S. Gov't, P.H.S.

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Matthew S Edwards, David B Wilson, Timothy E Craven, Jeanette Stafford, Linda F Fried, Tien Y Wong, Ronald Klein, Gregory L Burke, Kimberley J Hansen. 2005. Associations between retinal microvascular abnormalities and declining renal function in the elderly population: the Cardiovascular Health Study.. https://doi.org/10.1053/j.ajkd.2005.05.005

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2010

Common charge-shift mutation Glu65Lys in K+ channel β₁-Subunit KCNMB1: pleiotropic consequences for glomerular filtration rate and progressive renal disease.

BACKGROUND: Glomerular filtration rate (GFR) is a heritable trait, and hyperfiltration (GFR increment in remnant nephrons) may accelerate renal functional decline in chronic kidney disease (CKD). Mesangial and vascular smooth myocytes control GFR by contraction, dependent on voltage-gated Ca(2+) influx, which is controlled by the regulatory β₁-subunit (KCNMB1) of large-conductance heteromeric K+ ('BK') channels. KCNMB1 gain-of-function variant Glu65Lys results in generalized vasorelaxation and thus protection against systemic hypertension. Here we asked whether the Glu65Lys variant influences GFR, in the basal state or during progressive renal decline. METHODS: We explored Glu65Lys effects on GFR in three populations spanning two ethnicities and two diseases (hypertension and nephrosclerosis). GFR was either estimated (eGFR from serum creatinine) or directly measured (iothalamate clearance). RESULTS: The 65Lys variant was relatively common, occurring on ∼5-10% of chromosomes in different biogeographic ancestry groups, and 65Lys carriers exhibited higher eGFR in two primary care populations: extreme BP values in Kaiser clinics (p = 0.029, accounting for ∼0.2% of trait variance), or treated hypertensives in VA clinics (p = 0.017, accounting for ∼0.9% of trait variance). In blacks with progressive renal disease (NIDDK AASK), 65Lys carriers displayed a steeper slope in GFR chronic decline (p = 0.030, accounting for ∼0.4% of trait variance), and Glu65Lys genotype also predicted time of onset of renal failure (log rank p = 0.019). CONCLUSIONS: Common KCNMB1 gain-of-function variant Glu65Lys influences GFR, and 65Lys carriers exhibit not only elevated baseline GFR, but also more rapid GFR decline (and consequent development of renal failure) in CKD. The results suggest that profiling patients at Glu65Lys can assist in gauging renal prognosis as well as selection of rational therapy in hypertension with progressive renal disease.

Black or African American↗
PubMed2007

A retrospective case-control study of the use of hormone-related supplements and association with breast cancer.

Hormone-related supplements (HRS), many of which contain phytoestrogens, are widely used to manage menopausal symptoms, yet their relationship with breast cancer risk has generally not been evaluated. We evaluated whether use of HRS was associated with breast cancer risk, using a population-based case-control study in 3 counties of the Philadelphia metropolitan area consisting of 949 breast cancer cases and 1,524 controls. Use of HRS varied significantly by race, with African American women being more likely than European American women to use any herbal preparation (19.2% vs. 14.7%, p=0.003) as well as specific preparations including black cohosh (5.4% vs. 2.0%, p=0.003), ginseng (12.5% vs. 7.9%, p<0.001) and red clover (4.7% vs. 0.6%, p<0.001). Use of black cohosh had a significant breast cancer protective effect (adjusted odds ratio 0.39, 95% CI: 0.22-0.70). This association was similar among women who reported use of either black cohosh or Remifemin (an herbal preparation derived from black cohosh; adjusted odds ratio 0.47, 95% CI: 0.27-0.82). The literature reports that black cohosh may be effective in treating menopausal symptoms, and has antiestrogenic, antiproliferative and antioxidant properties. Additional confirmatory studies are required to determine whether black cohosh could be used to prevent breast cancer.

Black or African American↗
PubMed2007

Factors affecting outcomes after radical cystectomy in African Americans.

BACKGROUND: Previous studies indicate that African Americans with bladder cancer have a worse outcome than Caucasians. Delay in seeking care and higher stage at presentation have been cited as possible reasons for the observed differences. The authors hypothesized that differences in hospital volume where patients undergo radical cystectomy may be responsible for race-based differences in outcomes after the procedure. METHODS: The authors analyzed data from the Health Care Cost and Utilization Project and identified 4862 patients who had undergone radical cystectomy between 1998 and 2002. In-hospital mortality, complications, and length of stay (LOS) in hospital were compared between patients grouped by race. Hospitals were categorized into tertiles by the average number of radical cystectomies performed per year (1-4 radical cystectomies, 5-10 radical cystectomies, and >10 radical cystectomies). Univariate and multivariate analyses were performed to determine predictors of mortality, complications, LOS, and the likelihood that patients would undergo cystectomy at a high/medium-volume hospital. RESULTS: African Americans had the highest in-patient mortality, complications, and LOS after radical cystectomy. They also were the least likely to undergo radical cystectomy at a high/medium-volume hospital. When the analyses were controlled for potential confounding factors, there was no difference in in-hospital mortality by race, but differences persisted in the other 3 outcome variables. African Americans had higher odds of complications (odds ratio [OR], 1.57; P = .001), longer LOS (25%; P = .001), and lower odds of undergoing cystectomy at a high/medium-volume hospital (OR, 0.74; P = .03) compared with Caucasians. CONCLUSIONS: Race was an important factor in determining outcomes after radical cystectomy for bladder cancer. African Americans were less likely to undergo cystectomy at a high-volume hospital, thereby placing them at a higher risk of postoperative complications which ultimately may affect their survival.

Black or African American↗