Choroid structure analysis following initiation of hemodialysis by using swept-source optical coherence tomography in patients with and without diabetes

Abstract

We aimed to evaluate choroid structural changes using swept-source optical coherence tomography (SS-OCT) following hemodialysis initiation in diabetic and nondiabetic patients with end-stage kidney disease (ESKD). In this multicenter, prospective, cross-sectional study, diabetic (DM group; 30 eyes; 16 patients) and nondiabetic patients (NDM group; 30 eyes; 15 patients) with ESKD were evaluated after hemodialysis initiation. SS-OCT findings were analyzed using a manual delineation technique and binarization method before the first and last hemodialysis sessions, conducted approximately 2 weeks apart. Subfoveal choroidal thickness changes and mean large choroidal vessel layer thickness were significantly greater in the DM group (−13.3% ± 2.5% and −14.5% ± 5.2%, respectively) than the NDM group (−9.5% ± 3.1% and −9.2% ± 3.4%, respectively; p = 0.049 and p = 0.02, respectively). Binarized SS-OCT analysis revealed that the mean subfoveal choroidal area was significantly larger in the DM group (−21.9% ± 6.5%) than the NDM group (−17.2% ± 5.9%; p = 0.032). The change ratio in mean luminal area values was significantly greater in the DM group (−27.7% ± 8.7%) than the NDM group (−17.7% ± 5.8%; p = 0.007). The DM group exhibited substantial changes in the choroidal layer, possibly reflecting choroidal vascular disorders caused by diabetes.

Impact of Hemodialysis on Subfoveal Choroidal Thickness Measured by Optical Coherence Tomography: A Systematic Review and a Pooled Analysis of Self-Controlled Case Series

“…Figure 3 shows the meta-analysis of SCT change before and after HD. Two studies divided patients into a DM group and non-DM group; therefore, we collected and included the data respectively [ 23 , 26 ]. Two studies only included patients with ESKD without DM [ 25 , 29 ], and one study only included patients with ESKD with DM [ 22 ].…”

The Impact of a Single Haemodialysis Session on the Retinal Thickness and Optic Nerve Morphology

“…However, a significant number of studies indicate no effect of an HD session on RT or even a decrease in RT after HD [6,12,13,[16][17][18][19][20][21][22][23]25,26]. The differences may be due to small groups of subjects, methodological differences between studies, differences in the OCT types used, and differences in the groups of subjects themselves, including age, gender, axial length, refraction, or ethnic origin, all of which influence the retinal, GCL and pRNFL thickness [6,7,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]30]. The aetiology of CKD in the studied patients subjected to HD may be of particular importance with respect to differences in the obtained results.…”

“…The impact of DM and the associated microangiopathy may affect not only the baseline RT but also its response to HD. The available literature includes studies assessing RT in the NDM group only [7,15,18,25], mixed groups of DM and NDM patients [6,[12][13][14]16,17,19,[21][22][23]26] or DM patients who were also assessed with respect to the degree of DR or the presence of macular oedema [20,24,31].…”

“…As indicated above, the currently available study results are very diverse, and the reasons for the reduction, lack of reaction or increase in RT and pRNFL thickness following HD observed in previous studies are not clear [6,7,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]36]. There is no doubt that further research is needed, including the use of OCT-A, which will allow us to address changes in microcirculation and their potential impact on RT.…”

“…The way that the retina reacts to a single HD session is not obvious, and the studies give contradictory results, from RT decrease through no changes to RT thickness increase [6,7,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The changes regarding pRNFL also differ in respective studies [7,13,19,24].…”