Investigation of associations between retinal microvascular parameters and albuminuria in UK Biobank: a cross-sectional case-control study

on behalf of The UK Biobank Eye and Vision Consortium, Euan N. Paterson, Chris Cardwell, Thomas J. MacGillivray, Emanuele Trucco, Alexander S. Doney, Paul Foster, Alexander P. Maxwell, Gareth J. McKay*, Jennifer Yip

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review


    Background: Associations between microvascular variation and chronic kidney disease (CKD) have been reported previously. Non-invasive retinal fundus imaging enables evaluation of the microvascular network and may offer insight to systemic risk associated with CKD. 

    Methods: Retinal microvascular parameters (fractal dimension [FD] – a measure of the complexity of the vascular network, tortuosity, and retinal arteriolar and venular calibre) were quantified from macula-centred fundus images using the Vessel Assessment and Measurement Platform for Images of the REtina (VAMPIRE) version 3.1 (VAMPIRE group, Universities of Dundee and Edinburgh, Scotland) and assessed for associations with renal damage in a case-control study nested within the multi-centre UK Biobank cohort study. Participants were designated cases or controls based on urinary albumin to creatinine ratio (ACR) thresholds. Participants with ACR ≥ 3 mg/mmol (ACR stages A2-A3) were characterised as cases, and those with an ACR < 3 mg/mmol (ACR stage A1) were categorised as controls. Participants were matched on age, sex and ethnic background. 

    Results: Lower FD (less extensive microvascular branching) was associated with a small increase in odds of albuminuria independent of blood pressure, diabetes and other potential confounding variables (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.03–1.34 for arterioles and OR 1.24, CI 1.05–1.47 for venules). Measures of tortuosity or retinal arteriolar and venular calibre were not significantly associated with ACR. 

    Conclusions: This study supports previously reported associations between retinal microvascular FD and other metabolic disturbances affecting the systemic vasculature. The association between retinal microvascular FD and albuminuria, independent of diabetes and blood pressure, may represent a useful indicator of systemic vascular damage associated with albuminuria.

    Original languageEnglish
    Article number72
    JournalBMC Nephrology
    Issue number1
    Publication statusPublished - 25 Feb 2021

    Bibliographical note

    Funding Information: This study was supported by funding from the Northern Ireland Kidney Research Fund. The funding body played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

    Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

    Publisher Copyright: © 2021, The Author(s).

    Citation: Paterson, E.N., Cardwell, C., MacGillivray, T.J. et al. Investigation of associations between retinal microvascular parameters and albuminuria in UK Biobank: a cross-sectional case-control study. BMC Nephrol 22, 72 (2021).



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