The Microvasculature in Chronic Kidney Disease

Background and objectives Individuals with chronic kidney disease (CKD) stages 3 to 5 have an increased risk of cardiac and other vascular disease. Here we examined the association of CKD 3 to 5 with small vessel caliber. Design, setting, participants, & measurements This was a cross-sectional observational study of 126 patients with CKD stages 3 to 5 (estimated GFR [eGFR] <60 ml/min per 1.73 m(2)) and 126 age- and gender-matched hospital patients with CKD 1 or 2. Retinal vessel diameters were measured from digital fundus images by a trained grader using a computer-assisted method and summarized as the central retinal artery equivalent (CRAE) and central retinal vein equivalent (CRVE). Results Patients with CKD 3 to 5 had a smaller mean CRAE and CRVE than hospital controls (139.4 +/- 17.8 mu m versus 148.5 +/- 16.0 mu m, P < 0.001; and 205.0 +/- 30.7 mu m versus 217.4 +/- 25.8 mu m, respectively; P = 0.001). CRAE and CRVE decreased progressively with each stage of renal failure CKD1-2 to 5 (P for trend = 0.08 and 0.04, respectively). CKD and hypertension were independent determinants of arteriolar narrowing after adjusting for age, gender, diabetes, dyslipidemia, and smoking history. Patients with CKD 5 and diabetes had a larger mean CRAE and CRVE than nondiabetics (141.4 +/- 14.9 mu m versus 132.9 +/- 14.2 mu m; 211.1 +/- 34.4 mu m versus 194.8 +/- 23.8 mu m). Conclusions The microvasculature is narrowed in patients with reduced eGFR. Clin J Am Soc Nephrol 6: 1872-1878, 2011. doi: 10.2215/CJN.10291110