Hypertensive Retinopathy as a Window to Kidney Damage: A Severity Assessment Study in CKD Patients of Bastar, Chhattisgarh, India

Abstract

Background: Hypertension is a major contributor to chronic kidney disease (CKD) and systemic target-organ damage. Because the retinal and renal microvasculature share anatomical and physiological characteristics, hypertensive retinopathy may provide a non-invasive clinical marker of renal disease severity. This study assessed the severity of hypertensive retinopathy and its association with CKD stage in hypertensive patients.

Methods: A cross-sectional observational study was conducted over 15 months among 100 hypertensive patients aged ≥18 years with diagnosed CKD. Patients with diabetes mellitus, renal vascular abnormalities, glomerulonephritis, congenital renal anomalies, and renal tumours were excluded. All participants underwent detailed ophthalmic examination, including visual acuity, intraocular pressure measurement, and dilated fundus examination. Hypertensive retinopathy was graded using the Keith-Wagener-Barker classification. Blood pressure, CKD stage, serum creatinine, blood urea, and estimated glomerular filtration rate were recorded. Statistical analysis was performed using SPSS version 26, with p <0.05 considered statistically significant.

Results: The mean age of participants was 45.98 ± 14.45 years, with 54% females and 46% males. Hypertensive retinopathy was present in 84% of patients. Grade 1, 2, 3, and 4 retinopathy were observed in 20%, 32%, 24%, and 8% of patients, respectively. A statistically significant association was observed between CKD stage and severity of hypertensive retinopathy (p <0.05). Severe retinopathy (Grades 3–4) was more frequently observed in advanced CKD, particularly stages 4 and 5, whereas milder grades predominated in earlier CKD stages. Grade 4 retinopathy was associated with poorer visual acuity. Anaemia was present in 84% of patients and showed a significant association with CKD severity (p = 0.0085). No significant association was observed between intraocular pressure and retinopathy severity.

Conclusion: The study demonstrates a significant relationship between hypertensive retinopathy severity and CKD stage. Fundoscopic examination may therefore serve as a simple, non-invasive and cost-effective method for identifying hypertensive CKD patients at increased risk of advanced renal disease and visual impairment, particularly in resource-limited settings.