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Investigation of associations between retinal microvascular parameters and albuminuria in UK Biobank: a cross-sectional case-control study

Investigation of associations between retinal microvascular parameters and albuminuria in UK Biobank: a cross-sectional case-control study
Investigation of associations between retinal microvascular parameters and albuminuria in UK Biobank: a cross-sectional case-control study

Background: associations between microvascular variation and chronic kidney disease (CKD) have been reported previously. Non-invasive retinal fundus imaging enables evaluation of the microvascular network and may offer insight to systemic risk associated with CKD.

Methods: retinal microvascular parameters (fractal dimension [FD] – a measure of the complexity of the vascular network, tortuosity, and retinal arteriolar and venular calibre) were quantified from macula-centred fundus images using the Vessel Assessment and Measurement Platform for Images of the REtina (VAMPIRE) version 3.1 (VAMPIRE group, Universities of Dundee and Edinburgh, Scotland) and assessed for associations with renal damage in a case-control study nested within the multi-centre UK Biobank cohort study. Participants were designated cases or controls based on urinary albumin to creatinine ratio (ACR) thresholds. Participants with ACR ≥ 3 mg/mmol (ACR stages A2-A3) were characterised as cases, and those with an ACR < 3 mg/mmol (ACR stage A1) were categorised as controls. Participants were matched on age, sex and ethnic background. 

Results: lower FD (less extensive microvascular branching) was associated with a small increase in odds of albuminuria independent of blood pressure, diabetes and other potential confounding variables (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.03–1.34 for arterioles and OR 1.24, CI 1.05–1.47 for venules). Measures of tortuosity or retinal arteriolar and venular calibre were not significantly associated with ACR. 

Conclusions: this study supports previously reported associations between retinal microvascular FD and other metabolic disturbances affecting the systemic vasculature. The association between retinal microvascular FD and albuminuria, independent of diabetes and blood pressure, may represent a useful indicator of systemic vascular damage associated with albuminuria.

1471-2369
72
Paterson, Euan N.
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Hysi, Pirro
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Keane, Pearse A.
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Khaw, Sir Peng Tee
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Khawaja, Anthony
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Stratton, Irene
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on behalf of the UK Biobank Eye and Vision Consortium
Paterson, Euan N.
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Cardwell, Chris
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MacGillivray, Thomas J.
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Doney, Alexander S.
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Foster, Paul
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Maxwell, Alexander P.
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McKay, Gareth
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Barman, Sarah
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Barrett, Jenny
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Bishop, Paul
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Blows, Peter
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Khawaja, Anthony
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Lascaratos, Gerassimos
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Lotery, Andrew
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MacGillivray, Tom
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Mackie, Sarah
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Martin, Keith
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Morgan, James
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Self, Jay
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Stratton, Irene
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on behalf of the UK Biobank Eye and Vision Consortium (2021) Investigation of associations between retinal microvascular parameters and albuminuria in UK Biobank: a cross-sectional case-control study. BMC Nephrology, 22 (1), 72. (doi:10.1186/s12882-021-02273-6).

Record type: Article

Abstract

Background: associations between microvascular variation and chronic kidney disease (CKD) have been reported previously. Non-invasive retinal fundus imaging enables evaluation of the microvascular network and may offer insight to systemic risk associated with CKD.

Methods: retinal microvascular parameters (fractal dimension [FD] – a measure of the complexity of the vascular network, tortuosity, and retinal arteriolar and venular calibre) were quantified from macula-centred fundus images using the Vessel Assessment and Measurement Platform for Images of the REtina (VAMPIRE) version 3.1 (VAMPIRE group, Universities of Dundee and Edinburgh, Scotland) and assessed for associations with renal damage in a case-control study nested within the multi-centre UK Biobank cohort study. Participants were designated cases or controls based on urinary albumin to creatinine ratio (ACR) thresholds. Participants with ACR ≥ 3 mg/mmol (ACR stages A2-A3) were characterised as cases, and those with an ACR < 3 mg/mmol (ACR stage A1) were categorised as controls. Participants were matched on age, sex and ethnic background. 

Results: lower FD (less extensive microvascular branching) was associated with a small increase in odds of albuminuria independent of blood pressure, diabetes and other potential confounding variables (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.03–1.34 for arterioles and OR 1.24, CI 1.05–1.47 for venules). Measures of tortuosity or retinal arteriolar and venular calibre were not significantly associated with ACR. 

Conclusions: this study supports previously reported associations between retinal microvascular FD and other metabolic disturbances affecting the systemic vasculature. The association between retinal microvascular FD and albuminuria, independent of diabetes and blood pressure, may represent a useful indicator of systemic vascular damage associated with albuminuria.

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e-pub ahead of print date: 25 February 2021
Additional Information: Funding Information: This study was supported by funding from the Northern Ireland Kidney Research Fund. The funding body played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

Identifiers

Local EPrints ID: 447929
URI: http://eprints.soton.ac.uk/id/eprint/447929
ISSN: 1471-2369
PURE UUID: 12037fd8-7fa5-42f2-8653-aede6e971624
ORCID for Roxana Carare: ORCID iD orcid.org/0000-0001-6458-3776
ORCID for Sarah Ennis: ORCID iD orcid.org/0000-0003-2648-0869
ORCID for Jane Gibson: ORCID iD orcid.org/0000-0002-0973-8285
ORCID for Andrew Lotery: ORCID iD orcid.org/0000-0001-5541-4305
ORCID for Jay Self: ORCID iD orcid.org/0000-0002-1030-9963

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Date deposited: 26 Mar 2021 17:31
Last modified: 26 Nov 2021 02:50

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Contributors

Author: Euan N. Paterson
Author: Chris Cardwell
Author: Thomas J. MacGillivray
Author: Emanuele Trucco
Author: Alexander S. Doney
Author: Paul Foster
Author: Alexander P. Maxwell
Author: Gareth McKay
Author: Tariq Aslam
Author: Sarah Barman
Author: Jenny Barrett
Author: Paul Bishop
Author: Peter Blows
Author: Catey Bunce
Author: Roxana Carare ORCID iD
Author: Usha Chakravarthy
Author: Michelle Chan
Author: Antonietta Chianca
Author: Valentina Cipriani
Author: David Crabb
Author: Philippa Cumberland
Author: Alexander Day
Author: Parul Desai
Author: Bal Dhillon
Author: Andrew Dick
Author: Cathy Egan
Author: Sarah Ennis ORCID iD
Author: Marcus Fruttiger
Author: John Gallacher
Author: David (Ted) Garway-Heath
Author: Jane Gibson ORCID iD
Author: Dan Gore
Author: Jeremy Guggenheim
Author: Chris Hammond
Author: Alison Hardcastle
Author: Simon Harding
Author: Ruth Hogg
Author: Pirro Hysi
Author: Pearse A. Keane
Author: Sir Peng Tee Khaw
Author: Anthony Khawaja
Author: Gerassimos Lascaratos
Author: Andrew Lotery ORCID iD
Author: Phil Luthert
Author: Tom MacGillivray
Author: Sarah Mackie
Author: Keith Martin
Author: James Morgan
Author: Jay Self ORCID iD
Author: Irene Stratton
Corporate Author: on behalf of the UK Biobank Eye and Vision Consortium

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