Hypertensive Retinopathy Research Articles

Bilateral Retinal Haemorrhages as Primary Ocular Manifestation of Chronic Myeloid Leukaemia - A Case Report

Chronic myeloid leukaemia (CML) in a patient with pre.existing uncontrolled diabetes and hypertension is rarely encountered but must be detected early for appropriate management with systemic chemotherapy. Significant fundus finding mimic diabetic and hypertensive retinopathy, which makes the diagnosis of CML challenging. Early recognition and treatment of the underlying condition can prevent further vision loss and overall morbidity and mortality. Here, we report a case of bilateral retinal haemorrhages as one of the manifestations of CML.

The Spectrum of Ocular Manifestations among Renal Transplant Recipients

Purpose: The study aims to report various ocular manifestations among renal transplant recipients. Methods: The cross-sectional study was conducted on renal transplant patients, with at least 4 months of posttransplant duration, attending a nephrology clinic. A comprehensive ophthalmic evaluation was performed to record various ocular manifestations. The statistical association between ocular findings and pretransplant as well as posttransplant duration was assessed. Results: One hundred and twenty-three eyes of 62 patients, with a mean age of 37.6 ± 8.2 years and functional graft, were included in the study. Diabetic nephropathy was found to be the most common underlying cause of end-stage renal disease (ESRD) and renal transplant. Hypertensive retinopathy (37.4%) was found to be the most frequent ophthalmic manifestation, followed by diabetic retinopathy (24.39%), dry eye (22.76%), cataract (18.69%), and change in refractive error (17.89%). The occurrence of hypertensive retinopathy and refractive power change was found to be significantly associated with pretransplant dialysis duration. In contrast, concerning the posttransplant period, the frequency of all the major ocular manifestations, except the dry eye, was observed to be statistically significant. Conclusion: Patients with ESRD and renal transplant should be advised to undergo regular comprehensive eye examinations. Many ocular manifestations are preventable and/or treatable, thus interdisciplinary partnership between nephrologists and ophthalmologists is warranted to improve vision and quality of life in transplant recipients.

Commentary: The causal effect of hypertension, intraocular pressure, and diabetic retinopathy: a Mendelian randomization study.

Commentary: The causal effect of hypertension, intraocular pressure, and diabetic retinopathy: a Mendelian randomization study.

An Unusual Case of Anaemic Retinopathy Secondary to Iron Deficiency Anaemia

Anaemia has varied ocular presentations, ranging from simple conjunctival pallor to retinal abnormalities. Anaemic Retinopathy (AR) is a secondary retinal pathological symptom that can range from asymptomatic to developing retinal abnormalities. The increase in the severity of anaemia will ultimately increase the risk of retinopathy. While the outcomes might be similar to hypertensive or diabetic retinopathy, further comprehensive systemic and clinical evaluation is warranted. The incidence of AR, its associations with varying degrees of anaemia severity, and other haematological variables is still debated. Visual loss due to retinal abnormalities in anaemia is a rare clinical entity, despite its long-standing existence. Hereby, the authors present a case of a patient presenting with AR. A 19-year-old woman with a history of heavy menstrual bleeding was admitted for a sudden, painless, non progressive loss of vision in her left eye. Upon examination, her fundus revealed several Roth spots affecting all four quadrants and the macula, alongside a large and small preretinal haemorrhage in the nasal region and in the macula. Blood investigations revealed a Haemoglobin (Hb) of 2.4 g/dL and other reports suggestive of iron deficiency. She was diagnosed with iron-deficiency anaemia, with retinopathy as the most remarkable feature. She was treated with blood transfusion and Iron-folic Acid (IFA) supplementation, which showed a prompt response in the resolution of haemorrhage. She was discharged on IFA supplementation with planned follow-up for Ophthalmology and Gynaecology visits along with dietary advice.

A study to correlate hypertensive retinopathy with chronic kidney disease

A study to correlate hypertensive retinopathy with chronic kidney disease

Evaluation of Dinacharya in the Context of Netra

“Sarvaendriynam Nayanam Pradhanam” Chakshurindriya (eye) has been given utmost importance among all the sense organs i.e., nose, ear, eyes, tongue, skin by all the Acharyas. So, it must be protected wisely. Many eye disorders, including refractive errors, dry eye, computer vision syndrome, age-related macular degeneration, cataract, hypertensive retinopathy, diabetic retinopathy, and glaucoma, have been linked to the changing lifestyle of the modern era. This is especially with regard to the busy modern lifestyle and prolonged use of digital screens in our daily lives, from smartphone’s to computers. The daily routine for eye care as explained in Dincharya (daily regimen), involves a combination of preventive measures, therapeutic practices and lifestyle adjustments. These practices aim to balance the Doshas (internal energies) Vata, Pitta, Kapha associated with eye health. Ayurveda aims at prevention and cure of diseases and explains in detail the Rutucharya, Dinacharya, Sadvritta. In, eye care the Dincharya (daily regimen) includes Anjana (collyrium), Abhyanga (massage), Nasya (nasal instillation of drugs), Snana (bathing), Netraprakshalana (eye wash), Padabhyanga (foot massage), Padaprakshalana (cleaning of foot), and Padatra Dharana (use of footwear), Chhatra dharana, Netra Vyayama (eye exercise). Due to hazardous lifestyle, many people are not taking proper care of own self’s in the right way. Here, this review article explores the application of Dinacharya (daily regimen) principles specifically tailored for eye care, emphasizing a holistic approach to maintain ocular health.

TDCAU-Net: retinal vessel segmentation using transformer dilated convolutional attention-based U-Net method

Retinal vessel segmentation plays a vital role in the medical field, facilitating the identification of numerous chronic conditions based on retinal vessel images. These conditions include diabetic retinopathy, hypertensive retinopathy, glaucoma, and others. Although the U-Net model has shown promising results in retinal vessel segmentation, it tends to struggle with fine branching and dense vessel segmentation. To further enhance the precision of retinal vessel segmentation, we propose a novel approach called transformer dilated convolution attention U-Net (TDCAU-Net), which builds upon the U-Net architecture with improved Transformer-based dilated convolution attention mechanisms. The proposed model retains the three-layer architecture of the U-Net network. The Transformer component enables the learning of contextual information for each pixel in the image, while the dilated convolution attention prevents information loss. The algorithm efficiently addresses several challenges to optimize blood vessel detection. The process starts with five-step preprocessing of the images, followed by chunking them into segments. Subsequently, the retinal images are fed into the modified U-Net network introduced in this paper for segmentation. The study employs eye fundus images from the DRIVE and CHASEDB1 databases for both training and testing purposes. Evaluation metrics are utilized to compare the algorithm’s results with state-of-the-art methods. The experimental analysis on both databases demonstrates that the algorithm achieves high values of sensitivity, specificity, accuracy, and AUC. Specifically, for the first database, the achieved values are 0.8187, 0.9756, 0.9556, and 0.9795, respectively. For the second database, the corresponding values are 0.8243, 0.9836, 0.9738, and 0.9878, respectively. These results demonstrate that the proposed approach outperforms state-of-the-art methods, achieving higher performance on both datasets. The TDCAU-Net model presented in this study exhibits substantial capabilities in accurately segmenting fine branching and dense vessels. The segmentation performance of the network surpasses that of the U-Net algorithm and several mainstream methods.

A cross-sectional study to evaluate ocular manifestations in chronic kidney disease patients in a tertiary care centre

Chronic kidney disease (CKD) constitutes a major healthcare issue due to defective microcirculation secondary to systemic hypertension and diabetes mellitus. Hence, the aim is to find the prevalence of ocular pathology, risk factors and its association with the level of kidney function in patients with CKD undergoing haemodialysis. This prospective, cross-sectional study included 105 CKD patients referred to Ophthalmology Department in a tertiary care centre from November 2021 to April 2023. They were evaluated for demographic data, history of systemic comorbidities, visual acuity and ocular pathologies. This was correlated with the stages of CKD which is defined as the presence of glomerular filtration rate (GFR) < 60 mL/min/1.73 m2 and/or proteinuria. Chi-square test or Fischer’s exact test was used as test of significance for qualitative data and Independent t test was used as test of significance to identify the mean difference between two quantitative variables. ANOVA was used as test of significance to identify the mean difference between more than two quantitative variables. Out of 105 [74 (70.5%) male and 31(29.5%) females] CKD patients with mean age 58.43±13.05, ocular pathology was noted in 63 (60%) with hypertensive retinopathy in 47 (44.76%), diabetic retinopathy in 38 (36.19%), mixed retinopathy in 24 (22.85%), cataract in 24 (22.85%), glaucomatous changes in 5 (4.76%), ARMD in 4 (3.8%) and retinal vein occlusion in 3 (2.85%). The mean platelet volume also showed positive correlation with worsening stages of CKD (P-0.015), Hypertensive and diabetic retinopathy (P<0.001). Higher prevalence of ocular pathology 63 (60%) was observed in this study, re-emphasising that ocular screening is mandatory in all chronic kidney disease patients for early detection and initiation of prompt treatment to prevent ocular morbidity.

Incidence and determinants of hypertensive retinopathy in hypertension patients at a teaching hospital in North Western Karnataka

Persistently raised blood pressure not only leads to retinal vascular damage but also leads to systemic diseases. The retinal vasculature observation by fundoscopy offers a great opportunity to explore the association of systemic microvascular disease caused by hypertension. Hypertensive retinopathy (HR) is considered to be a marker for vascular disease and death. The aim of the present study was to find out the prevalence of hypertensive retinopathy among hypertensive subjects and assess the pattern of retinopathy and associated risk factors. This was a hospital based cross-sectional study conducted among hypertensive patients at a teaching hospital, for a period of 3 months.A total of 300 hypertensive patients formed the study population. The prevalence of the hypertensive retinopathy in the present study was 49.33%. Hypertensive retinopathy was more prevalent in men 62% than women 38%. The prevalence of grade 1 and grade 2 hypertensive retinopathies was 43.24% and 33.11% respectively and 20.95% and 2.7% had grade 3 and 4 respectively. The prevalence of retinopathy was found to be statistically higher in patients who had h/o hypertension for more than 5 years. The prevalence of hypertensive retinopathy was more common in age group >60yrs. The prevalence of target organ damage was higher in those having retinopathy.The prevalence of hypertensive retinopathy is high in the present study which reflects lack of awareness, patient compliance, sub optimal measures to control blood pressure and even lack of prompt follow up with ophthalmologists. There is need to spread awareness and take adequate measures to reduce the burden of hypertensive retinopathy.

Ambulatory Blood Pressure Monitoring versus Office Blood Pressure Monitoring to Identify the True Hypertension Status of Living Kidney Donors.

Ambulatory blood pressure monitoring (ABPM) is a reliable modality and is preferred over office blood pressure monitoring (OBPM) for detecting hypertension. However, despite its advantages, the utilization of 24-h ABPM in evaluating living kidney donors has not been universally adopted by transplant centers, partly because of the lack of data about the utility of ABPM. This study aimed to identify patients with masked and white-coat hypertension, thereby ensuring appropriate identification of their true hypertension status and assessments of the risk to donors. This study included 73 potential living kidney donors. BP was measured in the office using a standardized protocol as well as by ABPM. Detailed clinical and biochemical parameters were assessed. Target organ damage was assessed in all the donors by assessing proteinuria, hypertensive retinopathy, and echocardiography. Out of the 73 donors, 64.4% were females and 35.6% were males. The average age of individuals in our donor population was 42.0 ± 11.28 years. In total, 31.5% were detected to be hypertensive by OBPM. With ABPM, only 21.9% of donors were hypertensive. The overall prevalence of white-coat hypertension was 30.4%; that of masked hypertension was 6.0%. In donors diagnosed as hypertensive by OBPM, three individuals were identified as having target organ damage. However, two additional donors who were initially missed as hypertensive using OBPM had target organ damage. OBPM overestimated the prevalence of hypertension compared with ABPM. ABPM is the better modality in terms of diagnosing white coats and masked hypertension. ABPM also more reliably correlates with target organ damage than OBPM.

Association Between Obesity, Hypertension and Target Organ Damage in Children

Background: The author analysed the association between obesity and hypertension as well as the association between the degree of hypertension and target organ damage. Methods: 61 children with suspected hypertension were evaluated. Ambulatory blood pressure monitoring was done in all of them. An echocardiogram and ophthalmologic examination were done in all children with confirmed hypertension and high-normal blood pressure and testing for microalbuminuria in most of them. The association between obesity and hypertension and between the degree of hypertension and target organ damage was tested using the chi-squared (χ2) and exact Fisher (if needed) statistical test. Results: Nine children with confirmed hypertension (50%), 13 children with high normal blood pressure (61.9%), and 10 children with normal blood pressure (45.5%) were obese. There was no statistically significant association between obesity and hypertension (p = 0.82). 66.7% of patients with hypertension and 38.1% of those with high-normal blood pressure had left ventricular hypertrophy (p = 0.14). 38.9% of patients with hypertension and 9.5% of those with high-normal blood pressure had hypertensive retinopathy (p = 0.34). 43.8% of patients with hypertension but 57.9% of those with high-normal blood pressure had microalbuminuria (p = 0.69). There was no statistically significant association between the degree of hypertension and left ventricular hypertrophy, hypertensive retinopathy, or microalbuminuria. Conclusion: The presented study did not prove a statistically significant association between obesity and hypertension or between the degree of hypertension and target organ damage.

The study of retinopathies and choroidopathies in hypertensive cats

Systemic hypertension is a cardiovascular disease increasingly present in geriatric cats. Its consequences on the target organs are also particularly on the eye ,at the level of the retina. The afflicted individuals may present lesions of choroidopathy and hypertensive retinopathy. The objectives of the reported study were to evaluate the clinical and ophthalmological findings, the causes of systemic hypertension in these cats and to discuss the visual prognosis of the individuals. This retrospective study was carried out on a number of 14 patients. The selection criteria were represented by cats suffering from hypertensive retinopathy having a systolic blood pressure greater than 160 mmHg and having an ocular lesion: retinal vascular tortuosity, effusion, hemorrhage, retinal detachment or hyphema. Medical records were reviewed for individuals’ reports, the medical history, ophthalmic examination findings, and ocular ultrasound scans. Most cats were referred because they had decreased visual acuity (42.9%), a history of chronic kidney disease or even for hyphema, glaucoma and anisocoria. Auscultatory cardiac abnormalities were diagnosed in half of the individuals. Chronic kidney disease concomitant with systemic arterial hypertension was the most common (n=12), followed by hyperthyroidism (n=1). The four cats with blood pressure monitoring (n=4) after the administration of amlodipine showed a decrease in blood pressure.

Arteriovenous Length Ratio: A Novel Method for Evaluating Retinal Vasculature Morphology and Its Diagnostic Potential in Eye-Related Diseases.

Retinal imaging is a non-invasive technique used to scan the back of the eye, enabling the extraction of potential biomarkers like the artery and vein ratio (AVR). This ratio is known for its association with various diseases, such as hypertensive retinopathy (HR) or diabetic retinopathy, and is crucial in assessing retinal health. HR refers to the morphological changes in retinal vessels caused by persistent high blood pressure. Timely identification of these alterations is crucial for preventing blindness and reducing the risk of stroke-related fatalities. The main objective of this paper is to propose a new method for assessing one of the morphological changes in the fundus through morphometric analysis of retinal images. The proposed method in this paper introduces a novel approach called the arteriovenous length ratio (AVLR), which has not been utilized in previous studies. Unlike commonly used measures such as the arteriovenous width ratio or tortuosity, AVLR focuses on assessing the relative length of arteries and veins in the retinal vasculature. The initial step involves segmenting the retinal blood vessels and distinguishing between arteries and veins; AVLR is calculated based on artery and vein caliber measurements for both eyes. Nine equations are used, and the length of both arteries and veins is measured in the region of interest (ROI) covering the optic disc for each eye. Using the AV-Classification dataset, the efficiency of the iterative AVLR assessment is evalutaed. The results show that the proposed approach performs better than the existing methods. By introducing AVLR as a diagnostic feature, this paper contributes to advancing retinal imaging analysis. It provides a valuable tool for the timely diagnosis of HR and other eye-related conditions and represents a novel diagnostic-feature-based method that can be integrated to serve as a clinical decision support system.

Tubular Interstitial Nephritis Secondary to Herbal Consumption: Case Report and Literature Review

Acute tubular interstitial nephritis is a form of immune-mediated renal injury characterized by infiltration of immune cells in the renal tubulointerstitium, leading to oliguric or non-oliguric acute kidney injury. It manifests with systemic arterial hypertension, foamy urine, and sometimes with secondary anemia if there is progression to chronic renal disease. The diagnosis of certainty is made by biopsy, the initial treatment consists of identifying and removing the triggering agent to avoid further exposure to toxins, management of the acute renal lesion and in some cases, it may be decided to start corticosteroids to avoid progression to end-stage chronic kidney disease. We present the case of a 24-year-old female patient with a history of consumption of unspecified herbal medicine for aesthetic purposes 3 years prior to our evaluation, who debuted with hypertensive emergency manifested by hypertensive retinopathy, hypertensive renal vasculopathy and tubulointerstitial nephritis, successfully treated with the withdrawal of the aggressor agent, angiotensin converting enzyme inhibitors, nitrates and corticosteroids. After 6 months of follow-up, the patient is asymptomatic and with total recovery of the renal disease documented by normal creatinine in laboratory tests.

Penerapan Algoritma Convolutional Neural Network Untuk Menentukan Retinopati Hipertensi Melalui Citra Retina Fundus

Hypertension is a disease that spreads in the human body caused by increased blood pressure that exceeds normal limits. The increase occurs over a long period, causing complications in human organs that cannot be seen clearly, such as complications in the heart, kidneys, brain, and retina. One of the disorders or complications of high blood pressure is in the retina. The disorder in the retina can also be said as hypertensive retinopathy. Patients suffering from hypertensive retinopathy can only be diagnosed by an ophthalmologist; this is because hypertensive retinopathy cannot be seen with the naked eye. However, one of the earliest signs is the thinning of the arterioles, which can cause blindness. Therefore, computer-assisted processing and analysis of eye fundus images to identify hypertensive retinopathy is an important thing to do by applying the Convolutional Neural Network algorithm. There are nine Convolutional Neural Network architectures used, namely AlexNet, DenseNet, Inception-V3, InceptionResNetV2, Lenet-5, MobileNetV2, ResNet50, VGG16, and VGG19. Based on the experimental results, it was found that of the nine Convolutional Neural Network architectures, two of them, namely AlexNet and Lenet-5, obtained an F1 Measure value of 0.66 and the highest accuracy of 0.67.

HDR-EfficientNet: A Classification of Hypertensive and Diabetic Retinopathy Using Optimize EfficientNet Architecture.

Hypertensive retinopathy (HR) and diabetic retinopathy (DR) are retinal diseases closely associated with high blood pressure. The severity and duration of hypertension directly impact the prevalence of HR. The early identification and assessment of HR are crucial to preventing blindness. Currently, limited computer-aided methods are available for detecting HR and DR. These existing systems rely on traditional machine learning approaches, which require complex image processing techniques and are often limited in their application. To address this challenge, this work introduces a deep learning (DL) method called HDR-EfficientNet, which aims to provide an efficient and accurate approach to identifying various eye-related disorders, including diabetes and hypertensive retinopathy. The proposed method utilizes an EfficientNet-V2 network for end-to-end training focused on disease classification. Additionally, a spatial-channel attention method is incorporated into the approach to enhance its ability to identify specific areas of damage and differentiate between different illnesses. The HDR-EfficientNet model is developed using transfer learning, which helps overcome the challenge of imbalanced sample classes and improves the network's generalization. Dense layers are added to the model structure to enhance the feature selection capacity. The performance of the implemented system is evaluated using a large dataset of over 36,000 augmented retinal fundus images. The results demonstrate promising accuracy, with an average area under the curve (AUC) of 0.98, a specificity (SP) of 96%, an accuracy (ACC) of 98%, and a sensitivity (SE) of 95%. These findings indicate the effectiveness of the suggested HDR-EfficientNet classifier in diagnosing HR and DR. In summary, the HDR-EfficientNet method presents a DL-based approach that offers improved accuracy and efficiency for the detection and classification of HR and DR, providing valuable support in diagnosing and managing these eye-related conditions.

EPIDEMIOCLINICAL AND EVOLUTIONARY FEATURES OF OCULAR MANIFESTATIONS DURING PRE-ECLAMPSIA AND ECLAMPSIA AT THE YOPOUGON UNIVERSITY HOSPITAL

Introduction: Pre-eclampsia and eclampsia are obstetric emergencies involving maternal and foetal vital prognosis. They are providers of ocular complications.The aim of our study was to highlight the epidemioclinical and evolutionary features of these ocular lesions in pre-eclamptic and eclamptic patients.Methods: This was a prospective cross-sectional study with a descriptive purpose which was carried out over a period of 5 months from March 1 to July 31, 2021. It included all hospitalized pre-eclamptic and eclamptic patients.Results: We collected 33 cases of pre-eclampsia and eclampsia out of a total of 325 pregnant women that is a hospital prevalence of 9.37%. The average age of our patients was 29 years with extremes ranging from 17 to 45 years. Eclampsia accounted for 57.57% of the diagnosis and pre-eclampsia 42.42%. Visual acuity was normal in 42.42% of cases. Hypertensive retinopathy was detected in 63.63% of cases. The most severe fundus lesions were more common in pregnant women with severe pre-eclampsia and eclampsia. Regression of fundus lesions was visible in 79.17% of cases.Conclusion: Ocular lesions occur mainly in severe cases of pre-eclampsia and their research would improve their management.

Adaptive Deep Clustering Network for Retinal Blood Vessel and Foveal Avascular Zone Segmentation

Optical coherence tomography angiography (OCTA) is a new non-invasive imaging technology that provides detailed visual information on retinal biomarkers, such as the retinal vessel (RV) and the foveal avascular zone (FAZ). Ophthalmologists use these biomarkers to detect various retinal diseases, including diabetic retinopathy (DR) and hypertensive retinopathy (HR). However, only limited study is available on the parallel segmentation of RV and FAZ, due to multi-scale vessel complexity, inhomogeneous image quality, and non-perfusion, leading to erroneous segmentation. In this paper, we proposed a new adaptive segmented deep clustering (ASDC) approach that reduces features and boosts clustering performance by combining a deep encoder–decoder network with K-means clustering. This approach involves segmenting the image into RV and FAZ parts using separate encoder–decoder models and then employing K-means clustering on each part separated by the encoder–decoder models to obtain the final refined segmentation. To deal with the inefficiency of the encoder–decoder network during the down-sampling phase, we used separate encoding and decoding for each task instead of combining them into a single task. In summary, our method can segment RV and FAZ in parallel by reducing computational complexity, obtaining more accurate interpretable results, and providing an adaptive approach for a wide range of OCTA biomarkers. Our approach achieved 96% accuracy and can adapt to other biomarkers, unlike current segmentation methods that rely on complex networks for a single biomarker.

Impact of coronary artery bypass grafting surgery on the chorioretinal biomicroscopic characteristics.

Most patients with cardiovascular disorders suffer from coronary artery diseases, which can be treated successfully using coronary artery bypass grafting (CABG). One of the unpleasant events following CABG is postoperative vision loss (POVL). Vulnerability of retinal vessels to hemodynamic changes, an expectable event following CABG, may contribute to the development of POVL, which might be associated with the changes in the choroidal and retinal structures. To investigate postoperative changes in chorioretinal and peripapillary nerve fiber layer (NFL) thickness, and progression of diabetic and hypertensive retinopathy after CABG. In this prospective, cross-sectional study, 49 eyes in 25 candidates for CABG underwent both ophthalmic and cardiovascular examinations within 6 mo prior to and 9 mo after surgery. Among the study participants, 56% were male with a mean age of 62.84 years ± 10.49 years (range 33-80 years). Diabetes mellitus was observed in eight participants (32%). None of the patients suffered from postoperative anterior or posterior ischemic optic neuropathy, central retinal artery occlusion, and cortical blindness. The mean value of the preoperative best corrected visual acuity was 0.11 ± 0.10 logMAR (range, 0-0.4), which worsened to 0.15 ± 0.08 logMAR (range, 0-0.4) after CABG (P = 0.031). No significant difference was observed between the pre- and postsurgical choroidal (P = 0.853) and macular (P = 0.507) thickness, NFL thickness in the subfoveal (P > 0.999) and peripapillary areas (P = 0.659), as well as the severity of diabetic and hypertensive retinopathy. CABG may reduce visual acuity without affecting ocular structures. Postoperative vision reduction might be attributable to molecular or cellular variations, changes in visual pathway function, or central nervous system.

Predictors of Hyporesponsiveness to Erythropoiesis-Stimulating Agents in Patients with Non-Dialysis-Dependent Chronic Kidney Disease (RADIANCE-CKD Study)

Introduction: Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) has been associated with increased mortality and cardiovascular events in patients with chronic kidney disease. We hypothesized that the prediction of ESA resistance during ESA administration would be very useful in deciding on a treatment plan. Methods: Patients enrolled in a randomized controlled trial to evaluate renal prognosis in anemic patients with non-dialysis-dependent chronic kidney disease with hyporesponsiveness to ESA were included; the patients had different target hemoglobin levels. A landmark analysis was performed at 3 months into the study. To construct a predictive model for the severe ESA hypo-responder group, in which there was no increase in hemoglobin even with active treatment, background factors and serum test items that affect anemia at study entry were included in a logistic regression model, the area under the curve (AUC) and 95% confidence intervals (CI) were estimated, and sensitivity and specificity were calculated. This study was a post hoc sub-analysis of a randomized controlled trial. Results: The AUC for the 19 existing risk factors as predictors was 0.783 (95% CI: 0.711–0.855). Among the 19 risk factors, the combination of six factors (hemoglobin level, systolic blood pressure, weight, gender, smoking status, and hypertensive retinopathy) with the largest χ² statistics were selected by multiple logistics regression. The AUC for these 6 predictors was 0.716 (95% CI: 0.634–0.799). To the six existing risk factors, five serum test items that affect anemia (vitamin B12, vitamin B6, folic acid, parathyroid hormone, and 25-hydroxyvitamin D) were added, for a total of 11 risk factors, with a similar AUC of 0.736 (95% CI: 0.655–0.817), sufficient to predict ESA resistance. Conclusions: Our results suggest that existing risk factors and serum test items can be used to predict ESA resistance in patients with non-dialysis-dependent chronic kidney disease on ESA.