Associations between Chronic Kidney Disease and Thinning of Neuroretinal Layers in Multiethnic Asian and White Populations

Abstract

Purpose: To evaluate the relationships between chronic kidney disease (CKD) with retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness profiles of eyes in Asian and White populations. Design: Cross-sectional analysis. Participants: A total of 5066 Asian participants (1367 Malays, 1772 Indians, and 1927 Chinese) from the Singapore Epidemiology of Eye Diseases Study (SEED) were included, consisting of 9594 eyes for peripapillary RNFL analysis and 8661 eyes for GCIPL analysis. Additionally, 45 064 White participants (87 649 eyes) from the United Kingdom Biobank (UKBB) were included for both macular RNFL analysis and GCIPL analysis. Methods: Nonglaucoma participants aged ≥ 40 years with complete data for estimated glomerular filtration rate (eGFR) were included from both SEED and UKBB. In SEED, peripapillary RNFL and GCIPL thickness were measured by Cirrus HD-OCT 4000. In UKBB, macular RNFL and GCIPL were measured by Topcon 3D-OCT 1000 Mark II. Chronic kidney disease was defined as eGFR < 60 ml/min/1.73 m2 in both data sets. To evaluate the associations between kidney function status with RNFL and GCIPL thickness profiles, multivariable linear regression with generalized estimating equation models were performed in SEED and UKBB data sets separately. Main Outcome Measures: Average peripapillary and macular RNFL thickness and macular GCIPL thickness. Results: In SEED, after adjusting for age, gender, ethnicity, systolic blood pressure, antihypertensive medication, diabetes, hyperlipidemia, body mass index, smoking status, and intraocular pressure, presence of CKD (β = −1.31; 95% confidence interval [CI], −2.37 to −0.26; P = 0.015) and reduced eGFR (per 10 ml/min/1.73 m2; β = −0.32; 95% CI, −0.50 to −0.13; P = 0.001) were associated with thinner average peripapillary RNFL. Presence of CKD (β = −1.63; 95% CI, −2.42 to −0.84) and reduced eGFR (per 10 ml/min/1.73 m2; β = −0.30; 95% CI, −0.44 to −0.16) were consistently associated with thinner GCIPL in SEED (all P < 0.001). In UKBB, after adjusting for the above-mentioned covariates (except ethnicity), reduced eGFR (per 10 ml/min/1.73 m2; β = −0.06; 95% CI, −0.10 to −0.01; P = 0.008) was associated with thinner macular RNFL and CKD (β = −0.62; 95% CI, −1.16 to −0.08; P = 0.024) was associated with thinner average GCIPL. Conclusion: We consistently observed associations between CKD and thinning of RNFL and GCIPL across Asian and White populations' eyes. These findings further suggest that compromised kidney function is associated with RNFL and GCIPL thinning. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Keywords

• Asian
• Chronic kidney disease
• Ganglion cell-inner plexiform layer
• Retinal nerve fiber layer
• White