{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:30:38Z","timestamp":1788535838041,"version":"build-2803163510"},"reference-count":52,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2026,1]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Retinal imaging reveals microvascular changes associated with cardiovascular (CV) risk in patients with CKD.<\/jats:p>\n <\/jats:list-item>\n \n A retinal vascular model improves risk stratification compared with established clinical risk scores for CV events.<\/jats:p>\n <\/jats:list-item>\n \n Integrating retinal analysis with clinical markers enhances CV risk assessment in patients with CKD.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n \n Patients with CKD face an elevated but variable risk of cardiovascular (CV) disease. Retinal imaging in CKD provides a noninvasive opportunity for CV risk stratification through microvascular analysis. The objective of this study was to evaluate retinal vascular features extracted\n via<\/jats:italic>\n computer vision and machine learning approaches for CV risk and their added value over established risk calculators in patients with CKD.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Retinal scans from 1333 participants of the multicenter clinical observational study Chronic Renal Insufficiency Cohort (NCT00304148) were analyzed. A deep learning pipeline segmented vessels and then identified arterioles and venules from them. Segmented vessel, arteriole, and venule masks were used to extract 384 vascular features. An elastic-net model\u2014Cardiovascular Assessment through Retinal Evaluation in CKD (CARE-CKD; M\n CARE<\/jats:sub>\n )\u2014was trained, using the top eight features, on 567 participants (101 major adverse cardiovascular events [MACE]: composite of myocardial infarction, stroke, heart failure) and validated on 244 participants (44 MACE). A nomogram integrating M\n CARE<\/jats:sub>\n with clinical markers (age, sex, blood pressure, smoking, eGFR, albuminuria, cholesterol, body mass index, and diabetes status) was developed.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n M\n CARE<\/jats:sub>\n demonstrated strong prognostic performance for predicting MACE, (C-index=0.70, hazard ratio [HR] =3.95, above versus below median; 95% confidence interval [CI], 2.36 to 6.63;\n P<\/jats:italic>\n <0.001), outperforming the Framingham Risk Score (C-index=0.66; HR=1.06; Likelihood Ratio Test [LRT]\n P<\/jats:italic>\n < 0.01) and Predicting Risk of cardiovascular disease EVENTs (PREVENT; C-index=0.65; HR=1.84; LRT\n P<\/jats:italic>\n < 0.001) calculators. M\n CARE<\/jats:sub>\n improved risk stratification within Framingham Risk Score\u2013based high-risk (HR=3.73;\n P<\/jats:italic>\n < 0.001) and Predicting Risk of cardiovascular disease EVENT\u2013based high-risk (HR=4.73;\n P<\/jats:italic>\n < 0.001) categories. Nomogram enhanced risk stratification (C-index=0.77; HR=3.81;\n P<\/jats:italic>\n <0.0001) compared with clinical markers (LRT\n P<\/jats:italic>\n < 0.01).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n CARE-CKD provides a novel, opportunistic approach to CV risk assessment in CKD, outperforming the established risk calculators and refining stratification within high-risk categories. By enabling earlier identification, close monitoring, and targeted management of high-risk patients, CARE-CKD addresses gaps left by traditional calculators, maximizing the benefits of emerging therapies and potentially improving long-term outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000000955","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T16:01:02Z","timestamp":1755532862000},"page":"81-93","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Fundus Photograph-Derived Computational Features Predict Risk of Cardiovascular Events in the Chronic Renal Insufficiency Cohort Clinical Observational Study"],"prefix":"10.34067","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5213-3313","authenticated-orcid":false,"given":"Rohan","family":"Dhamdhere","sequence":"first","affiliation":[{"name":"The Wallace H. 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Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4154-0519","authenticated-orcid":false,"given":"Sebastian","family":"Medina","sequence":"additional","affiliation":[{"name":"The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4579-3449","authenticated-orcid":false,"given":"Sruthi","family":"Arepalli","sequence":"additional","affiliation":[{"name":"Emory Eye Center, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9025-7413","authenticated-orcid":false,"given":"Mahboob","family":"Rahman","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1122-7695","authenticated-orcid":false,"given":"Sadeer","family":"Al-Kindi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5741-0399","authenticated-orcid":false,"given":"Anant","family":"Madabhushi","sequence":"additional","affiliation":[{"name":"The Wallace H. 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