Evaluation of the Retinal Vasculature in Hypertension and Chronic Kidney Disease in an Elderly Population of Irish Nuns

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Abstract

Background

Chronic kidney disease (CKD) and hypertension are global public health problems associated with considerable morbidity, premature mortality and attendant healthcare costs. Previous studies have highlighted that non-invasive examination of the retinal microcirculation can detect microvascular pathology that is associated with systemic disorders of the circulatory system such as hypertension. We examined the associations between retinal vessel caliber (RVC) and fractal dimension (D _F), with both hypertension and CKD in elderly Irish nuns.

Methods

Data from 1233 participants in the cross-sectional observational Irish Nun Eye Study (INES) were assessed from digital photographs with a standardized protocol using computer-assisted software. Multivariate regression analyses were used to assess associations with hypertension and CKD, with adjustment for age, body mass index (BMI), refraction, fellow eye RVC, smoking, alcohol consumption, ischemic heart disease (IHD), cerebrovascular accident (CVA), diabetes and medication use.

Results

In total, 1122 (91%) participants (mean age: 76.3 [range: 56–100] years) had gradable retinal images of sufficient quality for blood vessel assessment. Hypertension was significantly associated with a narrower central retinal arteriolar equivalent (CRAE) in a fully adjusted analysis ( P = 0.002; effect size = -2.16 μm; 95% confidence intervals [CI]: -3.51, -0.81 μm). No significant associations between other retinal vascular parameters and hypertension or between any retinal vascular parameters and CKD were found.

Conclusions

Individuals with hypertension have significantly narrower retinal arterioles which may afford an earlier opportunity for tailored prevention and treatment options to optimize the structure and function of the microvasculature, providing additional clinical utility. No significant associations between retinal vascular parameters and CKD were detected.

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Most cited references 48

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Revised formulas for summarizing retinal vessel diameters.

Jae K. Lee, Ronald Klein, Laura L. Hubbard … (2003)

Background/Purpose. Recent findings suggest that an objective assessment of retinal vessel caliber from fundus photographs provide information about the association of microvascular characteristics with macrovascular disease. Current methods used to quantify retinal vessel caliber, introduced by Parr(1,2) and Hubbard,(3) are not independent of scale and are affected by the number of vessels. To improve upon these methods we introduce revised formulas for quantifying vessel caliber. Methods. Revised formulas were estimated using retinal vessel measurements from 44 young adults free of hypertension and diabetes. Comparisons between the two methods were done using digitized photographs from 4926 participants at the baseline examination of the Beaver Dam Eye Study (BDES), an ongoing population-based cohort study initiated in 1987. Individual arterioles and venules were measured using semi-automated computer software from which summary measures were calculated. Results. Correlation coefficients between the Parr-Hubbard and revised formulas were high (Pearson correlation coefficients ranging from 0.94 to 0.98). Both arteriolar and venular caliber significantly increased with an increasing number of vessels measured using the Parr-Hubbard formulas (p 0.50). Conclusions. We describe revised formulas for summarizing retinal vessel diameters measured from fundus photographs to be used in future studies and analyses. The revised formulas correlate highly with the previously used Parr-Hubbard formulas, but offer the advantages of being more robust against variability in the number of vessels observed, being independent of image scale, and being easier to implement.

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Microvascular network alterations in the retina of patients with Alzheimer's disease.

Tien-Yin Wong, Po-Chuan Chen, Dennis Seow … (2014)

Although cerebral small-vessel disease has been implicated in the development of Alzheimer's disease (AD), the cerebral microcirculation is difficult to visualize directly in vivo. Because the retina provides a noninvasive window to assess the microcirculation, we determined whether quantitatively measured retinal microvascular parameters are associated with AD. We conducted a case-control study (case:control matching ≈ 1:2). Retinal photographs were analyzed using a computer program, and a spectrum of quantitative retinal microvascular parameters (caliber, fractal dimension, tortuosity, and bifurcation) were measured. Logistic regression models were used to compute the odds ratio (OR) and 95% confidence interval for AD adjusting for age, gender, ethnicity, smoking, hypertension, diabetes, hypercholesterolemia, and history of myocardial infarction. We included 136 demented patients with AD and 290 age-gender-race-matched controls. Persons with narrower venular caliber (OR per standard deviation [SD] decrease, 2.01 [1.27-3.19]), decreased arteriolar and venular fractal dimension (OR per SD decrease 1.35 [1.08-1.68], 1.47 [1.17-1.84], respectively) and increased arteriolar and venular tortuosity (OR per SD increase, 1.84 [1.40-2.31], 1.94 [1.48-2.53], respectively) were more likely to have AD. These associations still persisted when only AD cases without a history of cerebrovascular disease were included. Patients with AD have altered microvascular network in the retina (narrower retinal venules and a sparser and more tortuous retinal vessels) compared with matched nondemented controls. These changes in retinal microvasculature may reflect similar pathophysiological processes in cerebral microvasculature in the brains of patients with AD. Copyright © 2014 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

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Chronic kidney disease management in the United Kingdom: NEOERICA project results.

N Hague, Jochem van der Voort van Zyp, R. Middleton … (2007)

Early identification of patients with chronic kidney disease (CKD) may allow health-care systems to implement interventions aimed at decreasing disease progression and eventual morbidity and mortality. Primary care in the United Kingdom is computerized suggesting a separate screening program for CKD may not be necessary because identifying data already populates primary care databases. Our study utilized a data set of 163 demographic, laboratory, diagnosis, and prescription variables from 130 226 adults in the regions of Kent, Manchester, and Surrey. The patients were 18 years of age and older in a 5-year study period culminating in November 2003. Estimated glomerular filtration rate was calculated from the four-variable Modification of Diet in Renal Disease equation using calibrated creatinine levels. A valid creatinine value was recorded in almost 30% of this cohort. The age-standardized prevalence of stage 3-5 CKD was 10.6% for females and 5.8% for males. In these patients, the odds ratio for hypertension was 2.1, for diabetes 1.33, and for cardiovascular disease 1.69. Only 20% of the diabetic people with stage 3-5 CKD had a blood pressure less than or equal to 130/80 mm Hg. The proportion of patients with anemia significantly rose as renal function declined. We suggest that stage 3-5 CKD is easily detected in existing computerized records. The associated comorbidity and management is readily available enabling intervention and targeting of specialist resources.

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Author and article information

Contributors

Fakir M Amirul Islam: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 1 September 2015

Publication date Collection: 2015

Volume: 10

Issue: 9

Electronic Location Identifier: e0136434

Affiliations

[1 ]Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland

[2 ]Centre for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland

[3 ]Department of Ophthalmology, Royal Victoria Hospital, Belfast, Northern Ireland

Swinburne University of Technology, AUSTRALIA

Author notes

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: GM GS. Performed the experiments: AMG. Analyzed the data: AMG CP GM. Contributed reagents/materials/analysis tools: EM VS. Wrote the paper: AMG GS CP APM GM.

* E-mail: g.j.mckay@ 123456qub.ac.uk

Article

Publisher ID: PONE-D-15-14527

DOI: 10.1371/journal.pone.0136434

PMC ID: 4556713

PubMed ID: 26327531

SO-VID: 105f08ee-d2d2-4322-8b7b-9f6f77c06e2a

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 8 April 2015

Date accepted : 3 August 2015

Page count

Figures: 2, Tables: 3, Pages: 14

Funding

This work was supported by the United Kingdom Medical Research Council Grant MR/K003364/1; Diabetes UK Grant 11/0004400; and the Northern Ireland Health & Personal Social Services Research and Development Office, Belfast, Grant Recognised Research Group Project 4.41. The funding organizations had no role in the design, conduct or reporting of this research.

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Data Availability Data presented are from the Irish Nun Eye study and there are ethical restrictions on providing unrestricted access. However, the authors confirm that an ethically compliant dataset will be made available upon request by contacting Dr Gareth McKay at Centre for Public Health, Queen's University Belfast, Northern Ireland, BT12 6BA. This study was approved by the Institutional Review Board and the Office for Research Ethics Committee Northern Ireland.

Evaluation of the Retinal Vasculature in Hypertension and Chronic Kidney Disease in an Elderly Population of Irish Nuns

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Abstract

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Most cited references 48

Revised formulas for summarizing retinal vessel diameters.

Microvascular network alterations in the retina of patients with Alzheimer's disease.

Chronic kidney disease management in the United Kingdom: NEOERICA project results.

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