Structural and microvascular changes in the retina and choroid in patients with chronic kidney disease

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PURPOSE

To study the main structural and microvascular changes in the retina and choroid in patients with diabetic retinopathy (DR) and chronic kidney disease (CKD), and their relationship with impaired renal function.

MATERIAL AND METHODS

The study included 158 patients (304 eyes). The 1^st group consisted of 50 patients with CKD (97 eyes); group 2 — 65 patients with DR (119 eyes), group 3 — 43 patients with CKD and DR (86 eyes). All study patients underwent complete ophthalmological examination, including optical coherence tomography (OCT) and OCT angiography (OCTA) of the macular region.

RESULTS

The analysis of structural parameters in groups of patients showed a decrease in the thickness of the ganglion cell layer and the inner plexiform layer of the retina in patients with DR (70.85±14.49 μm), with the lowest value in the CKD+DR group (65.84±15.34 μm) in comparison with the CKD group (75.64±10.32 μm). In the groups of patients with CKD, the thickness of the choroid (207.3±40.36 μm) was significantly reduced in comparison with the group of patients with DR (258.8±26.63 μm) and correlated with the stage of the disease. Patients in the CKD+DR group had the lowest perfusion and vascular density in the macular region (31.23±10.91% and 13.15±2.73 mm), an increase in the area and perimeter of the foveal avascular zone (0.55±0.26 mm², 3.30±0.84 mm). Pronounced correlations of decrease in choroidal thickness, vascular density, and perfusion volume with low glomerular filtration rate and CKD stage, as well as urea and creatinine levels were determined. An increase in the area of the foveal avascular zone correlated with lower retinal capillary density, decreased perfusion volume, and the stage of both DR and CKD.

CONCLUSION

Structural and hemodynamic disorders of the retina and choroid can be recognized as significant biomarkers for non-invasive diagnosis of microvascular complications of diabetes mellitus and impaired renal function.

Keywords:

diabetic retinopathy

chronic kidney disease

OCT

OCT angiography

vascular density

perfusion density

ganglion cells

foveolar avascular zone

Authors:

Fursova A.Zh.

Novosibirsk State Regional Clinical Hospital;
Novosibirsk State Medical University

Derbeneva A.S.

Novosibirsk State Regional Clinical Hospital;
Novosibirsk State Medical University

Vasilyeva M.A.

Novosibirsk State Regional Clinical Hospital

Tarasov M.S.

Novosibirsk State Regional Clinical Hospital;
Novosibirsk State Medical University

Nikulich I.F.

Novosibirsk State Regional Clinical Hospital;
Novosibirsk State Medical University

Gamza Yu.A.

Novosibirsk State Medical University;
Private Healthcare institution Clinical Hospital «RZD-Medicine» Novosibirsk

Received:

29.08.2021

Accepted:

31.10.2021

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