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Vincent Daien, Ryo Kawasaki, Max VILLAIN, Jean RIBSTEIN, Guilhem DU CAILAR, Albert MIMRAN, Pierre FESLER; Decrease in Retinal Vascular Caliber is associated with a Lower Renal Function in Normotensive and Treatment-Naïve Hypertensive Subjects. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2158.
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Microvascular change has been postulated to represent one of the key mechanisms of aging process of the kidney. Retinal vascular narrowing, which is non-invasively assessed in vivo, has been used as a marker of the altered microcirculation. The primary objective of this study was to assess the relation between retinal vascular caliber and renal function in normotensive (NT; systolic/diastolic blood pressure <140/90 mmHg) subjects and treatment-naïve hypertensive (HT) subjects.
Fifty-seven NT subjects and 48 HT subjects were recruited for this study. Their serum creatinine (SCreat) was < 1.5 mg/dL and they were all without diabetes. Retinal vascular caliber was measured from fundus photographs using semi-automated computer-assisted program and summarized as central retinal artery equivalents (CRAE) and central retinal venular equivalent (CRVE). Renal function was estimated with the glomerular filtration rate (eGFR) using the MAYO clinic quadratic equation.
Mean age of overall study subjects was 48+/-13 years old (mean +/- SD), and 50% were women. Mean SCreat was 0.79+/-0.17 mg/dl and eGFR was 113.7 +/-12 ml/min/1.73m²; with no significant differences between NT and HT subjects. The adjusted mean CRAE was significantly smaller in the HT group than in the NT group (136.4 +/-2.1 µm vs. 148.4 +/- 1.7 µm; P<0.0001). Adjusted mean CRVE was not significantly different between HT and NT (204.9 +/-3.2 µm vs. 210.4 +/- 2.6 µm; P=0.19). In all participants, CRAE and CRVE were positively and significantly correlated to eGFR (univariate r²=0.16, P= 0.001 and r²=0.14, P= 0.001, respectively). This relation with eGFR remained significant for CRAE and CRVE after adjusting for age, gender, mean arterial blood pressure, smoking, glycemia, body mass index, total cholesterol, triglycerides (model r²=0.49; P=0.0001 and model r² =0.29; P=0.002, respectively). When replacing eGFR by 1/Screat as possible predictive variables, the association between CRAE or CRVE and renal function remained significant (model r²=0.51, p=0.0001 and model r² =0.29; P=0.002, respectively).
In normotensive and treatment-naïve hypertensive subjects without renal failure, a decrease in retinal vascular caliber (CRAE and CRVE) is associated with a lower kidney function, independent of other potential confounding risk factors. This may suggest common process in the microcirculation in the retina and kidney, and warrants further studies to be documented.
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