TY - JOUR
T1 - Impaired Retinal Vessel Dilation Predicts Mortality in End-Stage Renal Disease
AU - Günthner, Roman
AU - Hanssen, Henner
AU - Hauser, Christine
AU - Angermann, Susanne
AU - Lorenz, Georg
AU - Kemmner, Stephan
AU - Matschkal, Julia
AU - Braunisch, Matthias C.
AU - Küchle, Claudius
AU - Renders, Lutz
AU - Moog, Philipp
AU - Wassertheurer, Siegfried
AU - Baumann, Marcus
AU - Hammes, Hans Peter
AU - Mayer, Christopher C.
AU - Haller, Bernhard
AU - Stryeck, Sarah
AU - Madl, Tobias
AU - Carbajo-Lozoya, Javier
AU - Heemann, Uwe
AU - Kotliar, Konstantin
AU - Schmaderer, Christoph
N1 - Publisher Copyright:
© 2019 American Heart Association, Inc.
PY - 2019/6/7
Y1 - 2019/6/7
N2 - Rationale: Patients with end-stage renal disease are characterized by increased cardiovascular and all-cause mortality because of advanced remodeling of the macrovascular and microvascular beds. Objective: The aim of this study was to determine whether retinal microvascular function can predict all-cause and cardiovascular mortality in patients with end-stage renal disease. Methods and Results: In the multicenter prospective observational ISAR study (Risk Stratification in End-Stage Renal Disease), data on dynamic retinal vessel analysis were available in a subcohort of 214 dialysis patients (mean age, 62.6±15.0; 32% women). Microvascular dysfunction was quantified by measuring maximum arteriolar dilation and maximum venular dilation (vMax) of retinal vessels in response to flicker light stimulation. During a mean follow-up of 44 months, 55 patients died, including 25 cardiovascular and 30 noncardiovascular fatal events. vMax emerged as a strong independent predictor for all-cause mortality. In the Kaplan-Meier analysis, individuals within the lowest tertile of vMax showed significantly shorter 3-year survival rates than those within the highest tertile (66.9±5.8% versus 92.4±3.3%). Univariate and multivariate hazard ratios for all-cause mortality per SD increase of vMax were 0.62 (0.47-0.82) and 0.65 (0.47-0.91), respectively. Maximum arteriolar dilation and vMax were able to significantly predict nonfatal and fatal cardiovascular events (hazard ratio, 0.74 [0.57-0.97] and 0.78 [0.61-0.99], respectively). Conclusions: Our results provide the first evidence that impaired retinal venular dilation is a strong and independent predictor of all-cause mortality in hemodialyzed end-stage renal disease patients. Dynamic retinal vessel analysis provides added value for prediction of all-cause mortality and may be a novel diagnostic tool to optimize cardiovascular risk stratification in end-stage renal disease and other high-risk cardiovascular cohorts.
AB - Rationale: Patients with end-stage renal disease are characterized by increased cardiovascular and all-cause mortality because of advanced remodeling of the macrovascular and microvascular beds. Objective: The aim of this study was to determine whether retinal microvascular function can predict all-cause and cardiovascular mortality in patients with end-stage renal disease. Methods and Results: In the multicenter prospective observational ISAR study (Risk Stratification in End-Stage Renal Disease), data on dynamic retinal vessel analysis were available in a subcohort of 214 dialysis patients (mean age, 62.6±15.0; 32% women). Microvascular dysfunction was quantified by measuring maximum arteriolar dilation and maximum venular dilation (vMax) of retinal vessels in response to flicker light stimulation. During a mean follow-up of 44 months, 55 patients died, including 25 cardiovascular and 30 noncardiovascular fatal events. vMax emerged as a strong independent predictor for all-cause mortality. In the Kaplan-Meier analysis, individuals within the lowest tertile of vMax showed significantly shorter 3-year survival rates than those within the highest tertile (66.9±5.8% versus 92.4±3.3%). Univariate and multivariate hazard ratios for all-cause mortality per SD increase of vMax were 0.62 (0.47-0.82) and 0.65 (0.47-0.91), respectively. Maximum arteriolar dilation and vMax were able to significantly predict nonfatal and fatal cardiovascular events (hazard ratio, 0.74 [0.57-0.97] and 0.78 [0.61-0.99], respectively). Conclusions: Our results provide the first evidence that impaired retinal venular dilation is a strong and independent predictor of all-cause mortality in hemodialyzed end-stage renal disease patients. Dynamic retinal vessel analysis provides added value for prediction of all-cause mortality and may be a novel diagnostic tool to optimize cardiovascular risk stratification in end-stage renal disease and other high-risk cardiovascular cohorts.
KW - dialysis
KW - humans
KW - microcirculation
KW - renal insufficiency
KW - retinal vessels
KW - venules
UR - https://www.scopus.com/pages/publications/85073776104
U2 - 10.1161/CIRCRESAHA.118.314318
DO - 10.1161/CIRCRESAHA.118.314318
M3 - Article
C2 - 30929571
AN - SCOPUS:85073776104
SN - 0009-7330
VL - 124
SP - 1796
EP - 1807
JO - Circulation Research
JF - Circulation Research
IS - 12
ER -