Renal Function Markers Predict Risk of Specific Fundus Lesions in CKD: A Cross- Sectional Risk-Stratification Study

Objectives To investigate the association between renal function markers and fundus damage in patients with chronic kidney disease(CKD). Methods Basic demographic information, renal function parameters, and data related to fundus lesions were collected. The correlations between kidney disease and ocular disease, as well as the associations between renal function markers and various ocular pathologies, were analyzed. Results Analysis of odds ratios (OR) between ocular and renal variables revealed a significantly increased risk of ocular diseases in patients with kidney disease, with particularly elevated risks for retinal hemorrhage and macular edema. Boxplot analyses further demonstrated that specific fundus phenotypes, such as retinal exudates, retinal hemorrhage, and macular edema, were significantly associated with markers of renal impairment, including estimated glomerular filtration rate (eGFR), serum creatinine, blood urea nitrogen, urinary protein, and urinary microalbumin. Further analysis of eGFR data indicated that for every 10 ml/(min·1.73 m²) decrease in eGFR, the risks of retinal hemorrhage, diabetic retinopathy, macular edema, hypertensive retinopathy, and retinal exudates increased by 27%, 25%, 20%, 20%, and 12%, respectively. Conclusions Patients with kidney disease have a significantly increased risk of developing ocular diseases, particularly retinal hemorrhage and macular edema. There are significant differences in specific fundus phenotypes according to markers of renal impairment, suggesting that renal dysfunction may indirectly elevate the risk of retinal lesions and macular edema by affecting systemic vascular health. Moreover, a decline in eGFR is closely associated with increased risks of various ocular diseases.