Associations between Chronic Kidney Disease and Thinning of Neuroretinal Layers in Multi-ethnic Asian and Caucasian Populations

PurposeTo evaluate the relationships between chronic kidney disease (CKD) with retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness profiles in Asian and Caucasian eyes.DesignCross-sectional analysisParticipants5066 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 Caucasian participants (87 649 eyes) from the UK Biobank (UKBB) were included for both macular RNFL analysis and GCIPL analysis.MethodsNon-glaucoma participants aged ≥40 years with complete data of 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. CKD was defined as eGFR<60 ml/min/1.73m2Tham Y.-C. Li X. Wong T.Y. et al.Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040: A Systematic Review and Meta-Analysis.Ophthalmology. 2014; 121: 2081-2090Abstract Full Text Full Text PDF PubMed Scopus (3617) Google Scholar in both datasets. 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 datasets separately.Main Outcome MeasuresAverage peripapillary and macular RNFL thickness; macular GCIPL thicknessResultsIn SEED, after adjusting for age, gender, ethnicity, systolic blood pressure, anti-hypertensive medication, diabetes, hyperlipidemia, body mass index, smoking status and intraocular pressure, presence of CKD (β=-1.31; 95% CI -2.37 to -0.26; P=0.015) and reduced eGFR (per 10ml/min/1.73m2Tham Y.-C. Li X. Wong T.Y. et al.Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040: A Systematic Review and Meta-Analysis.Ophthalmology. 2014; 121: 2081-2090Abstract Full Text Full Text PDF PubMed Scopus (3617) Google Scholar; 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 10ml/min/1.73m2Tham Y.-C. Li X. Wong T.Y. et al.Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040: A Systematic Review and Meta-Analysis.Ophthalmology. 2014; 121: 2081-2090Abstract Full Text Full Text PDF PubMed Scopus (3617) Google Scholar; 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 10ml/min/1.73m2Tham Y.-C. Li X. Wong T.Y. et al.Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040: A Systematic Review and Meta-Analysis.Ophthalmology. 2014; 121: 2081-2090Abstract Full Text Full Text PDF PubMed Scopus (3617) Google Scholar; 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.ConclusionWe consistently observed associations between CKD and thinning of RNFL and GCIPL across Asian and Caucasian eyes. These findings further suggest that compromised kidney function is associated with RNFL and GCIPL thinning.