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Prevalence of Fundus Pathology in the Chronic Renal Insufficiency Cohort (CRIC) Study

¹Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania
²Medicine, University of Michigan, Ann Arbor, Michigan
³Medicine, University of Illinois, Chicago, Illinois
⁴Medicine, Kaiser Permanente Northern California, Oakland, California
⁵Medicine, University of Pennsylvania Medical School, Philadelphia, Pennsylvania

Commercial Relationships: J.E. Grunwald, None; J. Alexander, None; R. Whittock, None; K. McWilliams, None; C.A. Gadegbeku, None; J.P. Lash, None; J.C. Lo, None; R. Townsend, None.

Support: NIDDK grant DK074151, Vivian S. Lasko Research Fund, Nina C. Mackall Trust, Research to Prevent Blindness

Abstract

Purpose:To describe the prevalence of fundus pathology in the CRIC study, a multi-center longitudinal study of individuals with chronic kidney disease (CKD) followed for CKD progression and cardiovascular (CVD) events.

Methods:During a CRIC annual examination, 45º digital photos of the disc and macula were obtained by non-ophthalmologic personnel using a non-mydriatic Cannon CR-Dgi fundus camera. Photographs were obtained in 1613 patients participating in 6 CRIC centers and were assessed in a masked fashion by a retinal specialist. The purpose of this review was to quickly inform patients of the need for a complete eye examination by an ophthalmologist. Mean age was: 58±11 years (± 1SD), range 21-75 years; mean systolic blood pressure: 127±21 mmHg, range 73-243 mmHg; mean diastolic pressure: 72±13 mmHg, range 35-139 mmHg; estimated mean glomerular filtration rate: 44.9±13.7 mL/min/1.73m² ; range 13.5-93.6 mL/min/1.73m². Racial distribution was: 50% Caucasian, 44.8% African American and 5.2% other. 54.3% of the participants were male. Systemic hypertension was present in 83.7%, and diabetes mellitus was present in 44.2% of the subjects.

Results:Among the 1613 patients reviewed, 721 (45%) patients required a follow up examination by an ophthalmologist because of mild to severe pathologic fundus findings. Retinopathy (diabetic and/or hypertensive) was observed in 373 (23%) patients. Optic disc cup-to-disc ratio larger than 0.7 was observed in 144 (9%) patients. Age related macular degeneration and drusen were detected in 127 (8%) patients. Miscellaneous abnormal findings such as pigmentary changes and vitreous opacities were seen in 94 (6%) patients. Nevi were observed in 19 (1%) patients. Embolic plaques were seen in 7 patients. In 7% (50 patients) of the 721 patients with fundus abnormalities we found serious eye conditions, such as diabetic retinopathy (40 patients) and others (10 patients), that required urgent follow up.

Conclusions:Our results show a high prevalence of fundus pathology suggesting that these patients should receive a complete eye examination. Quantitative assessment of retinopathy and retinal vascular calibers in this study will further elucidate the relationship between retinal vascular changes and CKD and CVD.

Keywords: imaging/image analysis: clinical • diabetic retinopathy • clinical (human) or epidemiologic studies: prevalence/incidence

© 2008, The Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Permission to republish any abstract or part of an abstract in any form must be obtained in writing from the ARVO Office prior to publication.