Retinal neurovascular characteristics for the diagnosis and staging of nondiabetic chronic kidney disease:a diagnostic study  

作　　者：Wai Cheng Iao Xiayin Zhang Lanqin Zhao Dong Liu Jingyi Wen Xia Chen Qian Wang Huiqun Li Yanru Chen Tong Han Zengchun Ye Qianni Wu Duoru Lin Hui Xiao Hui Peng Haotian Lin 丘蔚晴;张夏茵;赵兰琴;刘冬;温静怡;陈霞;王倩;李慧群;陈彦茹;韩彤;叶增纯;吴倩妮;林铎儒;肖辉;彭晖;林浩添(State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science,Guangdong Provincial Clinical Research Center for Ocular Diseases,Guangzhou 510060,China;Department of Nephrology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Ophthalmology,Guangdong Eye Institute,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China;Hainan Eye Hospital and Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Haikou 570311,China;Center for Precision Medicine and Department of Genetics and Biomedical Informatics,Zhongshan School of Medicine,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]State Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science,Guangdong Provincial Clinical Research Center for Ocular Diseases,Guangzhou 510060,China [2]Department of Nephrology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China [3]Department of Ophthalmology,Guangdong Eye Institute,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China [4]Hainan Eye Hospital and Key Laboratory of Ophthalmology,Zhongshan Ophthalmic Center,Sun Yat-sen University,Haikou 570311,China [5]Center for Precision Medicine and Department of Genetics and Biomedical Informatics,Zhongshan School of Medicine,Sun Yat-sen University,Guangzhou 510080,China

出　　处：《Eye Science》2024年第4期358-373,共16页眼科学报(英文版)

基　　金：supported by the National Natural Science Foundation of China(92368205);the National Natural Science Foundation of China(82171035);the High-level Science and Technology Journals Projects of Guangdong Province(2021B1212010003);the Science and Technology Planning Project of Guangdong Province(2023A1111120011);the Science and Technology Planning Project of Guangzhou City(2024B03J1233);the Science and Technology Planning Projects of Guangdong Province(2021B1111610006);the Basic Scientific Research Projects of Sun Yat-sen University(23ykcxqt002);China Chronic Kidney Disease Management Innovation Program(202206080010);the National Natural Science Foundation of China(82170762);the National Natural Science Foundation of Guangdong,China(2022A1515012637);“Three big”Construction of Large Science Program of Sun Yat-sen University,China(82000-18843406).

摘　　要：Aims:To identify the characteristic retinal neurovascular changes in patients in different stages of nondiabetic chronic kidney disease(CKD)and to develop a model for the accurate diagnosis of nondiabetic CKD.Methods:Peripapillary retinal nerve fiber layer(pRNFL)thickness and average macular ganglion cell-inner plexiform layer(GC-IPL)thickness of nondiabetic CKD patients and healthy controls(HC)were evaluated by spectral-domain optical coherence tomography(OCT).The vessel density(VD)and perfusion density(PD)of the macula were obtained from optical coherence tomography angiography(OCTA).The estimated glomerular filtration rate(eGFR)was obtained to access the kidney function of CKD patients.Multiple linear regression models were used to adjust for confounding factors in statistical analyzes.The diagnostic capabilities of the parameters were evaluated by logistic regression models.Results:131 nondiabetic CKD patients and 62 HC entered the study.eGFR was found significantly associated with parafoveal VD and PD(average PD:β=0.0004,P_(adjusted)<0.001)in various sectors.Thinning of pRNFL(β=−6.725,P_(adjusted)<0.001)and GC-IPL(β=−4.542,P_(adjusted)<0.001),as well as decreased VD(β=−2.107,P_(adjusted)<0.001)and PD(β=−0.057,P_(adjusted)=0.0328)were found in CKD patients.Thinning of pRNFL and deteriorated perifoveal vasculature were found in early CKD,and the parafoveal and foveal VD significantly declined in advanced CKD.Logistic regression models were employed,and selected neurovascular parameters showed an AUC of 0.853(95%CI:0.795 to 0.910)in distinguishing CKD patients from HC.Conclusions:Distinctive retinal neurovascular characteristics could be observed in nondiabetic CKD patients of different severities.Our results suggest that retinal manifestations could be valuable in the screening,diagnosis,and follow-up evaluation of patients with CKD.

关 键 词：retinal neuorvascular characteristics chronic kidney disease optical coherence tomography angiography 

分 类 号：R69[医药卫生—泌尿科学]