Retinal neurovascular changes in chronic kidney disease

Wu, I‐Wen; Sun, Chi‐Chin; Lee, Chin‐Chan; Liu, Chunfu; Wong, Tien Yin; Chen, Shin‐Yi; Huang, Jerry Chien-Chieh; Tseng, Chung‐Hsin; Yeung, Ling

doi:10.1111/aos.14395

Cited by 17 publications

(24 citation statements)

References 37 publications

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“…A recent populationbased study consisting of 4464 non-glaucoma, multi-ethnic Asian participants showed that the presence of CKD is significantly associated with thinner GC-IPL (Tham et al, 2020). Furthermore, a prior study (Wu et al, 2020) also confirmed that macular thinning (GC-IPL and RNFLt) is a characteristic of retinal neural impairment in patients with CKD and such impairment is strongly associated with decreased eGFR. However, the definition of CKD applied in the aforementioned studies was based on an eGFR of <60 ml/min/1.73 m 2 (CKD stages 3-5) and failed to include earlier stages CKD patients with an eGFR of > 60 ml/min/1.73 m 2 (namely, CKD stages 1-2) using parameters such as proteinuria or UACR to detect early renal damage and declining renal function.…”

Section: Discussionmentioning

confidence: 90%

“…However, those studies failed to included CKD patients at the early stages (stages 1–2), so it still reminds unknown whether retinal neurovascular impairment occurs in earlier stages of CKD and what are the related factors for such damage. Furthermore, the inclusion of diabetes mellitus (DM) patients and dialysis population in prior studies challenge the direct comparison between CKD patients and normal subjects ( Yeung et al, 2019 ; Wu et al, 2020 ), as both DM ( Zeng et al, 2019 ; Zhuang et al, 2020 ) and dialysis ( Wu et al, 2020 ) can deteriorate neurovascular system independent of declining renal function.…”

Section: Introductionmentioning

confidence: 99%

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Retinal Neurovascular Impairment in Non-diabetic and Non-dialytic Chronic Kidney Disease Patients

Zeng

Chen

et al. 2021

Front. Neurosci.

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Background: Widespread neural and microvascular injuries are common in chronic kidney disease (CKD), increasing risks of neurovascular complications and mortality. Early detection of such changes helps assess the risks of neurovascular complications for CKD patients. As an extension of central nervous system, the retina provides a characteristic window to observe neurovascular alterations in CKD. This study aimed to determine the presence of retinal neurovascular impairment in different stages of CKD.Methods: One hundred fifteen non-diabetic and non-dialytic CKD patients of all stages and a control group of 35 healthy subjects were included. Retinal neural and microvascular parameters were obtained by optical coherence tomography angiography (OCTA) examination.Results: CKD 1–2 group (versus control group) had greater odds of having decreased retinal ganglion cell-inner plexiform layer thickness (GC-IPLt) (odds ratio [OR]: 0.92; 95% confidence interval [CI]: 0.86–0.98), increased ganglion cell complex-focal loss volume (GCC-FLV) (OR: 3.51; 95% CI: 1.27–9.67), and GCC-global loss volume (GCC-GLV) (OR: 2.48; 95% CI: 1.27–4.82). The presence of advanced stages of CKD (CKD 3–5 group versus CKD 1–2 group) had greater odds of having decreased retinal vessel density in superficial vascular plexus (SVP)-WholeImage (OR: 0.77, 95% CI: 0.63–0.92), SVP-ParaFovea (OR: 0.83, 95% CI: 0.71–0.97), SVP-ParaFovea (OR: 0.76, 95% CI: 0.63–0.91), deep vascular plexus (DVP)-WholeImage (OR: 0.89, 95% CI: 0.81–0.98), DVP-ParaFovea (OR: 0.88, 95% CI: 0.78–0.99), and DVP-PeriFovea (OR: 0.90, 95% CI: 0.83–0.98). Besides, stepwise multivariate linear regression among CKD patients showed that β2-microglobulin was negatively associated with GC-IPLt (β: –0.294; 95% CI: –0.469 ∼ –0.118), and parathyroid hormone was positively associated with increased GCC-FLV (β: 0.004; 95% CI: 0.002∼0.006) and GCC-GLV (β: 0.007; 95% CI: 0.004∼0.01). Urine protein to creatinine ratio was positively associated with increased GCC-FLV (β: 0.003; 95% CI: 0.001∼0.004) and GCC-GLV (β: 0.003; 95% CI: 0.001∼0.006).Conclusion: Retinal neuronal impairment is present in early stages of CKD (stages 1–2), and it is associated with accumulation of uremic toxins and higher UACR, while retinal microvascular hypoperfusion, which is associated with worse eGFR, was only observed in relatively advanced stages of CKD (stages 3–5). The results highlight the importance of monitoring retinal neurovascular impairment in different stages of CKD.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Retinal Neurovascular Impairment in Non-diabetic and Non-dialytic Chronic Kidney Disease Patients

Zeng

Chen

et al. 2021

Front. Neurosci.

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“…Microvascular rarefaction in both SVP and DVP has been found in patients with CKD, but the role of hypertension is yet to be determined 12 , 13 , 19 , 20 . The effect of blood pressure on different layers of retinal microvasculature is controversial, and diverse results have been found in patients with hypertension 10 , 15 – 17 .…”

Section: Discussionmentioning

confidence: 99%

“…Using OCTA, we had demonstrated decreased parafoveal microvascular vessel densities in both superficial vascular plexus (SVP) and deep vascular plexus (DVP) in patients with CKD 12 . eGFR was an independent factor associated with SVP vessel density 12 , 13 . However, the pathogenesis of these microvascular rarefactions in patients with CKD is yet to be determined 2 , 12 .…”

Section: Introductionmentioning

confidence: 94%

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Impact of blood pressure control on retinal microvasculature in patients with chronic kidney disease

Peng

Lee

et al. 2020

Sci Rep

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Chronic kidney disease (CKD) is an emerging disease worldwide. We investigated the relationship between blood pressure (Bp) control and parafoveal retinal microvascular changes in patients with CKD. This case-control study enrolled 256 patients with CKD (stage 3-5) and 70 age-matched healthy controls. Optical coherence tomography angiography showed lower superficial vascular plexus (SVP) vessel density, lower deep vascular plexus (DVP) vessel density, and larger SVP flow void area in the CKD group. The BP parameters at enrollment and during the year before enrollment were collected in patients with CKD. Partial correlation was used to determine the relationship between BP parameters and microvascular parameters after controlling for age, sex, diabetes mellitus, axial length, and intraocular pressure. The maximum systolic blood pressure (SBP) (p = 0.003) and within-patient standard deviation (SD) of SBP (p = 0.006) in 1 year were negatively correlated with SVP vessel density. The average SBP (p = 0.040), maximum SBP (p = 0.001), within-patient SD of SBP (p < 0.001) and proportion of high BP measurement (p = 0.011) in 1 year were positively correlated with the SVP flow void area. We concluded that long-term SBP was correlated with SVP microvascular injury in patients with CKD. Superficial retinal microvascular changes may be a potential biomarker for prior long-term BP control in these patients. Chronic kidney disease (CKD) is an emerging disease worldwide that is highly prevalent in elderly individuals and in patients with hypertension or diabetes mellitus (DM) 1. Approximately 10-15% of the world's population have CKD 2 , and the prevalence could be as high as 40% among diabetic patients 3. CKD is associated with many systemic vascular complications such as atherosclerosis, cerebrovascular disease, and cardiovascular disease 1. End-stage kidney disease may increase the risk of cardiovascular mortality by 10-30 folds 1. Retinal vasculature, which can be directly visualized using non-invasive tools, has been considered a potential window for systemic vascular complications 4-6. Fundus photography provided a convenient tool for correlating the risk of systemic vascular diseases and retinal vasculature [e.g. the central retinal arteriolar equivalent (CRAE) and the central retinal venular equivalent (CRVE)] 5. However, recent publications showed that systemic diseases may cause retinal capillary alterations preceding any visible pathology in fundus 7-9. Optical coherence tomography angiography (OCTA) technology provides a rapid non-invasive method to quantify microvasculature at the capillary level in the different retinal layers. It could detect early subtle retinal microvascular changes from systemic diseases 8-11. Using OCTA, we had demonstrated decreased parafoveal microvascular vessel densities in both superficial vascular plexus (SVP) and deep vascular plexus (DVP) in patients with CKD 12. eGFR was an independent

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Retinal Neurodegeneration and Visual Acuity Decline in Patients with Chronic Kidney Disease

Sun

Lee

et al. 2022

Ophthalmol Ther

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Introduction: Chronic kidney disease (CKD) has been associated with accelerated retinal neurodegeneration. The purpose of this study is to evaluate the association between retinal neurodegeneration and the best-corrected visual acuity (BCVA) decline in patients with CKD. Methods: Post hoc analysis of two prospective studies. Patients with CKD stage C 3 were enrolled. Macular thickness, peripapillary retinal nerve fiber layer (pRNFL) thickness, and macular ganglion cell complex (GCC) thickness were measured by optical coherence tomography. Eyes were classified into three groups: Group 1, no GCC defect; Group 2, GCC defect confined to parafoveal area; and Group 3, GCC defects extending beyond the parafoveal area. Each group was matched for age, sex, axial length, lens status, and cataract grading. Results: A total of 120 eyes (40 eyes in each group) from 120 patients (age 63.0 ± 10.3 years) were included. The logMAR BCVA was 0.076 ± 0.101, 0.100 ± 0.127, and 0.196 ± 0.191 in Group 1, 2, and 3, respectively. Group 3, but not Group 2, had a significantly worse BCVA than Group 1. In simple linear regression, parafoveal inner retinal thickness, pRNFL thickness, presence of pRNFL defect, GCC thickness, GCC global loss volume, GCC focal loss volume, and GCC defect extending Chi-Chin Sun and I-Wen Wu contributed equally to this work, and are co-first authors.

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Retinal neurovascular changes in chronic kidney disease

Cited by 17 publications

References 37 publications

Retinal Neurovascular Impairment in Non-diabetic and Non-dialytic Chronic Kidney Disease Patients

Retinal Neurovascular Impairment in Non-diabetic and Non-dialytic Chronic Kidney Disease Patients

Impact of blood pressure control on retinal microvasculature in patients with chronic kidney disease

Retinal Neurodegeneration and Visual Acuity Decline in Patients with Chronic Kidney Disease

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