Vadalà Maria, Castellucci Massimo, Guarrasi Giulia, Terrasi Micol, La Blasca Tiziana, Mulè Giuseppe
Dipartimento di Biomedicina Sperimentale e Neuroscienze cliniche, Sezione di Oftalmologia, University of Palermo, Via Liborio Giuffrè 13, 90127, Palermo, Italy.
Dipartimento Biomedico di Medicina Interna e Specialistica, Università di Palermo, Palermo, Italy.
Graefes Arch Clin Exp Ophthalmol. 2019 Aug;257(8):1687-1698. doi: 10.1007/s00417-019-04358-3. Epub 2019 May 30.
Retinal and choroidal microvascular changes can be related to renal impairment in hypertension and chronic kidney disease (CKD). The study examines the association between retinochoroidal parameters and renal impairment in hypertensive, non-diabetic patients.
This is a cross-sectional study on Caucasian patients with systemic arterial hypertension with different levels of renal function. All subjects were studied by blood chemistry, urine examination, microalbuminuria and blood pressure. Complete eye examination was completed with swept source optical coherence tomography (SS-OCT) and optical coherence tomography angiography (OCTA) scans of macular region. Patients were divided in groups: LowGFR and HighGFR and CKD- and CKD+, according to the value of glomerular filtrate (GFR) and albuminuria. LowGFR and CKD+ groups included patients with clinical kidney impairment.
One hundred and twenty eyes of 120 hypertensive patients were evaluated. The mean retinal thickness was thinner in CKD+ versus CKD- group (p < 0.009). LowGFR and CKD+ groups showed thinner choroidal values than HighGFR (p < 0.02) and CKD- (p < 0.001) groups. OCTA showed lower density in LowGFR than in HighGFR group (p < 0.001) and in CKD+ versus CKD- group (p < 0.001). Albuminuria was inversely related to choroidal and retinal thickness measures (p < 0.001) and to the indices of superficial parafoveal (p < 0.05) and foveal (p < 0.05) vascular densities.
CKD is associated with retinal thinning, eGFR and decreasing renal function with progressive reduction of choroidal and retinal vascular density. SS-OCT and OCTA documented close association between CKD and reduction of both choroidal thickness and paracentral retinal vascular density in hypertensive patients.
视网膜和脉络膜微血管变化可能与高血压和慢性肾脏病（CKD）中的肾功能损害有关。本研究探讨高血压非糖尿病患者视网膜脉络膜参数与肾功能损害之间的关联。
这是一项针对不同肾功能水平的白种人系统性动脉高血压患者的横断面研究。所有受试者均接受血液化学、尿液检查、微量白蛋白尿和血压检查。使用扫频源光学相干断层扫描（SS-OCT）和黄斑区光学相干断层扫描血管造影（OCTA）扫描完成全面的眼部检查。根据肾小球滤过率（GFR）和白蛋白尿的值，将患者分为低GFR组、高GFR组、CKD-组和CKD+组。低GFR组和CKD+组包括临床肾功能损害患者。
对120例高血压患者的120只眼睛进行了评估。CKD+组的平均视网膜厚度比CKD-组更薄（p < 0.009）。低GFR组和CKD+组的脉络膜厚度值比高GFR组（p < 0.02）和CKD-组（p < 0.001）更薄。OCTA显示低GFR组的密度低于高GFR组（p < 0.001），且CKD+组低于CKD-组（p < 0.001）。白蛋白尿与脉络膜和视网膜厚度测量值（p < 0.001）以及浅表旁中心凹（p < 0.05）和中心凹（p < 0.05）血管密度指数呈负相关。
CKD与视网膜变薄、估算肾小球滤过率（eGFR）以及随着脉络膜和视网膜血管密度逐渐降低的肾功能下降有关。SS-OCT和OCTA记录了CKD与高血压患者脉络膜厚度和视网膜旁中心血管密度降低之间的密切关联。
