The CRIC study has enrolled thousands of patients and has been running nearly two decades. Credit: Penn Medicine

A Penn Medicine observational study found that chronic kidney disease (CKD) patients with retinopathy are at greater risk of developing end-stage renal disease and cardiovascular disease (CVD). 

The multicentre, longitudinal Chronic renal insufficiency cohort (CRIC) study established that CKD patients often develop CVD and retinopathy. The study built on that to assess the association between retinopathy progression and concurrent incidence of CVD events in CKD participants.  

Using non-invasive, photographic tests, 1051 out of 1936 CRIC participants had fundus photographs taken at two timepoints separated by 3.5 years on average. Data was collected using standard protocols; presence and severity of retinopathy (diabetic, hypertensive or other) and vessel diameter calibre were assessed along with CVD events. Kidney function, proteinuria measurements and CVD risk factors were obtained at study visits. 

Analysing the data, researchers found retinopathy progression is associated with a higher incidence of CVD events. “Worsening of retinopathy by two or more steps in the EDTRS retinopathy grading scale was observed in 9.8% of participants and was associated with increased risk of incidence of CVD in analysis, adjusting for other CVD and CKD risk factors,” said study lead, Professor Juan Grunwald.  

Furthermore, retinal-vascular pathology may be indicative of macrovascular disease even after adjustment for kidney diseases and CVD risk factors, added Prof Grunwald concluding that assessment of retinal morphology may provide important information when assessing CVD in patients with CKD.