Deep learning–based detection of early renal function impairment using retinal fundus images: Model development and validation

Background: Retinal imaging has been applied for detecting eye diseases and cardiovascular risks using deep learning–based methods. Furthermore, retinal microvascular and structural changes were found in renal function impairments. However, a deep learning–based method using retinal images for detecting early renal function impairment has not yet been well studied. Objective: This study aimed to develop and evaluate a deep learning model for detecting early renal function impairment using retinal fundus images. Methods: This retrospective study enrolled patients who underwent renal function tests with color fundus images captured at any time between January 1, 2001, and August 31, 2019. A deep learning model was constructed to detect impaired renal function from the images. Early renal function impairment was defined as estimated glomerular filtration rate <90 mL/min/1.73 m². Model performance was evaluated with respect to the receiver operating characteristic curve and area under the curve (AUC). Results: In total, 25,706 retinal fundus images were obtained from 6212 patients for the study period. The images were divided at an 8:1:1 ratio. The training, validation, and testing data sets respectively contained 20,787, 2189, and 2730 images from 4970, 621, and 621 patients. There were 10,686 and 15,020 images determined to indicate normal and impaired renal function, respectively. The AUC of the model was 0.81 in the overall population. In subgroups stratified by serum hemoglobin A_1c (HbA_1c) level, the AUCs were 0.81, 0.84, 0.85, and 0.87 for the HbA_1c levels of ≤6.5%, >6.5%, >7.5%, and >10%, respectively. Conclusions: The deep learning model in this study enables the detection of early renal function impairment using retinal fundus images. The model was more accurate for patients with elevated serum HbA_1c levels.