Faculty Collaboration Database

Retinopathy and CKD as predictors of all-cause and cardiovascular mortality: National Health and Nutrition Examination Survey (NHANES) 1988-1994. Am J Kidney Dis 2014 Aug;64(2):198-203

Date

03/25/2014

Pubmed ID

24656452

Pubmed Central ID

PMC4111992

DOI

10.1053/j.ajkd.2014.01.437

Scopus ID

2-s2.0-84905089065 (requires institutional sign-in at Scopus site)   28 Citations

Abstract

BACKGROUND: Retinopathy is associated with increased mortality risk in general populations. We evaluated the joint effect of retinopathy and chronic kidney disease (CKD) on mortality in a representative sample of U.S. adults.

STUDY DESIGN: Prospective cohort study.

SETTING & PARTICIPANTS: 7,640 adults from NHANES (National Health and Nutrition Examination Survey) 1988-1994 with mortality linkage through December 31, 2006.

PREDICTORS: CKD, defined as low estimated glomerular filtration rate (<60 mL/min/1.73 m2) or albuminuria (urine protein-creatinine ratio ≥30 mg/g), and retinopathy, defined as the presence of microaneurysms, hemorrhages, exudates, microvascular abnormalities, or other evidence of diabetic retinopathy by fundus photograph.

OUTCOMES: All-cause and cardiovascular mortality.

MEASUREMENTS: Multivariable-adjusted Cox proportional hazards.

RESULTS: Overall, 4.6% of participants had retinopathy and 15% had CKD. Mean age was 56 years, 53% were women, and 81% were non-Hispanic whites. The prevalence of retinopathy in patients with CKD was 11%. We identified 2,634 deaths during 14.5 years' follow-up. In multivariable analyses, compared with individuals with neither CKD nor retinopathy, HRs for all-cause mortality were 1.02 (95% CI, 0.75-1.38), 1.52 (95% CI, 1.35-1.72), and 2.39 (95% CI, 1.77-3.22) for individuals with retinopathy only, those with CKD only, and those with both CKD and retinopathy, respectively. Corresponding HRs for cardiovascular mortality were 0.96 (95% CI, 0.50-1.84), 1.72 (95% CI, 1.47-2.00), and 2.96 (95% CI, 2.11-4.15), respectively. There was a significant synergistic interaction between retinopathy and CKD on all-cause mortality (P=0.04).

LIMITATIONS: The presence of retinopathy was evaluated only once. Small sample size of some of the subpopulations studied.

CONCLUSIONS: In the presence of CKD, retinopathy is a strong predictor of mortality in this adult population.

Author List

Ricardo AC, Grunwald JE, Parvathaneni S, Goodin S, Ching A, Lash JP

Author

Alice Ching MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Cardiovascular Diseases
Cohort Studies
Female
Follow-Up Studies
Humans
Hypertensive Retinopathy
Male
Middle Aged
Nutrition Surveys
Predictive Value of Tests
Prospective Studies
Randomized Controlled Trials as Topic
Renal Insufficiency, Chronic