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G. Liew, P. Mitchell, T. Y. Wong, S. K. Iyengar, J. J. Wang, Blue Mountains Eye Study Group; Relationship of Chronic Kidney Disease and Age-Related Maculopathy: The Blue Mountains Eye Study. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2120.
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. Chronic kidney disease (CKD) and age-related maculopathy (ARM) may share common genetic risk factors, such as complement factor H (CFH) and apolipoprotein E (APOE) genes, but no clinical studies have examined whether these diseases are linked. We aimed to explore this relationship in a population-based sample.
The Blue Mountains Eye Study (1992-4) surveyed 3654 residents aged 49+ living in 2 geographically defined areas west of Sydney, Australia. We measured serum creatinine from 3183 participants (87.1%) who had blood collected and estimated glomerular filtration rate (GFR) using the Modified Diet Renal Disease (MDRD) equation. CKD was defined according to National Kidney Foundation criteria as GFR<60 ml/min/1.73m2. We graded stereoscopic retinal photographs of both eyes for presence of early ARM (soft indistinct or reticular drusen or combined soft distinct drusen and retinal pigment abnormality) and late ARM (neovascular ARM or geographic atrophy).
CKD was present in 1488 persons (46.7%) and either early or late ARM was present in 149 persons (4.7%) and 61 persons (1.9%), respectively. Subjects with CKD were more likely to have early (6.2% vs 3.4%) and late (3.5% vs 0.5%) ARM than those without CKD. After adjusting for age (continuous), sex, smoking (current, ex, never) and pack years of cigarette smoking, CKD was significantly associated with late ARM (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.0-4.5) but not with early ARM (OR 1.0, CI 0.7-1.5). Each standard deviation (SD) decrease in log GFR was associated with higher prevalence of late ARM (OR 1.3, CI 1.1-1.7) but not early ARM (OR 1.0, CI 0.8-1.2). These findings were similar after additional adjustment for fibrinogen, white cell count, hypertension,diabetes and diabetes duration (OR 1.3, CI 1.0-1.6 for late ARM, and OR 1.0, CI 0.8-1.2 for early ARM, per SD decrease in log GFR.).
In this older Australian population, persons with CKD were more likely to have late ARM. This could represent a further manifestation of the systemic effects of common genes such as CFH on the vascular bed in the kidney and the eye.
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