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

Xiaomin Zeng,Baoyi Liu,Ying Fang,Yu Xiao,Zijing Du,Cong Li,Xiaohong Yang,Yun Ren,Pingting Zhong,Honghua Yu,Huiqian Kong,Yijun Hu,Yuanhan Chen,Zhanjie Lin,Yingying Liang,Zhiming Ye,Guanrong Wu

doi:10.3389/fnins.2021.703898

Abstract

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.

Highlights

As an emerging public health issue, chronic kidney disease (CKD) is predicted to be the fifth most common cause of death worldwide by 2040 (Foreman et al, 2018)
The CKD 3–5 group showed significantly higher results of systolic blood pressure (SBP), diastolic blood pressure (DBP), Hb1Ac, serum creatinine (Scr), blood urea nitrogen (BUN), best-corrected visual acuity (BCVA), as well as decreased estimated glomerular filtration rate (eGFR) and HGB compared to the CKD 1–2 group and the control group
The CKD 3–5 group showed significantly higher results of age, body mass index (BMI), parathyroid hormone (PTH), β2-M, history of hypertension, and cardiovascular disease (CVD) compared to the CKD 1–2 group

Summary

Introduction

As an emerging public health issue, chronic kidney disease (CKD) is predicted to be the fifth most common cause of death worldwide by 2040 (Foreman et al, 2018). Endocrine failure, and impaired vascular homeostasis result in widespread neural and microvascular injury (Futrakul et al, 2008). OCTA has been used to monitor retinal neural and microvascular alterations in degenerative neural diseases such as Alzheimer’s disease (O’bryhim et al, 2018; Den Haan et al, 2019) and Parkinson’s disease (Kashani et al, 2021; Robbins et al, 2021). Widespread neural and microvascular injuries are common in chronic kidney disease (CKD), increasing risks of neurovascular complications and mortality. Detection of such changes helps assess the risks of neurovascular complications for CKD patients. This study aimed to determine the presence of retinal neurovascular impairment in different stages of CKD

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Discussion

Conclusion