Centre for Public Health, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA.
Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, USA.
BMC Nephrol. 2020 Jan 31;21(1):37. doi: 10.1186/s12882-019-1679-1.
Tissue derived biomarkers may offer utility as indicators of accumulated damage. Reduced thickness of retinal neuronal tissue and the vascular choroid have previously been associated with vascular damage and diabetes. We evaluated associations between retinal thickness, retinal microvascular and choroidal measures, and renal function in a population with a high burden of comorbidity.
Participants were recruited from nuclear cardiology or renal medicine clinics. Retinal and choroidal thickness were measured from spectral-domain optical coherence tomograms. Retinal microvascular parameters were assessed from digital fundus photographs using a semi-automated software package.
Chronic kidney disease (CKD) categorised as: CKD stages 1-2, eGFR ≥60 ml/min/1.73m; CKD stage 3, eGFR 30-59 ml/min/1.73m, and CKD stages 4-5, eGFR ≤29 ml/min/1.73m.
Participants (n = 241) had a mean age of 65 years and a mean eGFR of 66.9 ml/min/1.73m. Thirty-nine % of the cohort had diabetes and 27% were using diuretics. Thinning of the inner retina and changes to its microvascular blood supply were associated with lower eGFR and CKD stages 4 and 5, while no associations were found between the outer retinal layers or their choroidal blood supply and CKD of any stage. These associations remained following adjustment for age, mean arterial blood pressure, diabetes status, low-density lipoprotein, body mass index, and sex.
Inner retinal thinning and retinal microvascular variation is associated with advanced CKD (stages 4 & 5) independent of important confounding factors, but not with earlier stage CKD (stage 3) and, therefore, its utility as a biomarker for early CKD is not supported in this study.
组织衍生生物标志物可能可作为累积损伤的指标。视网膜神经组织变薄和脉络膜血管先前与血管损伤和糖尿病有关。我们评估了在患有高合并症负担的人群中，视网膜厚度、视网膜微血管和脉络膜测量值与肾功能之间的相关性。
参与者从核心脏病学或肾脏医学诊所招募。使用谱域光学相干断层扫描仪测量视网膜和脉络膜厚度。使用半自动软件包从数字眼底照片评估视网膜微血管参数。
慢性肾脏病（CKD）分为：CKD 1-2 期，eGFR≥60ml/min/1.73m；CKD 3 期，eGFR 30-59ml/min/1.73m；CKD 4-5 期，eGFR≤29ml/min/1.73m。
参与者（n=241）的平均年龄为 65 岁，平均 eGFR 为 66.9ml/min/1.73m。39%的队列患有糖尿病，27%的人使用利尿剂。内视网膜变薄和其微血管血液供应的变化与较低的 eGFR 和 CKD 4 和 5 期相关，而在外视网膜层及其脉络膜血液供应与任何 CKD 阶段之间没有发现相关性。在调整年龄、平均动脉血压、糖尿病状态、低密度脂蛋白、体重指数和性别后，这些相关性仍然存在。
内视网膜变薄和视网膜微血管变化与晚期 CKD（4 期和 5 期）相关，独立于重要的混杂因素，但与早期 CKD（3 期）无关，因此，其作为早期 CKD 生物标志物的效用在本研究中未得到支持。
