Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit / Medical Research Foundation, University of Western Australia, Perth, WA, Australia.
Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.
J Clin Hypertens (Greenwich). 2021 Feb;23(2):309-316. doi: 10.1111/jch.14138. Epub 2020 Dec 19.
Patients with progressing chronic kidney disease (CKD) are more likely to experience cardio- and cerebrovascular events than progressing to end-stage renal disease. The authors explored whether retinal microvascular calibers differed with the degree of renal impairment and between the standard and extended optic disk and may serve as a simple additional tool for risk stratification in this highly vulnerable patient cohort. The authors analyzed central retinal arteriolar and venular equivalent calibers (CRAE, CRVE) at different retinal zones (zone B&C) using digital retinal imaging in hypertensive patients with stage 2 (n = 66) or stage 3 CKD (n = 30). Results were adjusted for age, sex, HbA1c, and 24-hour diastolic blood pressure. Mean eGFR was 77.7 ± 8.9 and 48.8 ± 7.9 ml/min/1.73 m for stage 2 and 3 CKD, respectively. CRAE and CRVE in zones B and C were significantly lower in patients with stage 3 CKD compared to patients with stage 2 CKD (CRAE-B:141.1 ± 21.4 vs. 130.5 ± 18.9 µm, p = .030; CRAE-C:137.4 ± 19.4 vs 129.2 ± 18.2 µm, p = .049; CRVE-B:220.8 ± 33.0 vs. 206.0 ± 28.4 µm, p = .004; and CRVE-C:215.9 ± 33.0 vs. 201.2 ± 25.1µm, p = .003). In patients with stage 2 CKD, CRAE-B was higher than CRAE-C (141.1 ± 21.4 vs. 137.4 ± 19.4µm, p < .001). In contrast, such a difference was not found in patients with stage 3 CKD. CRAE of both retinal zones correlated with eGFR for the entire cohort. In patients with stage 3 CKD, retinal narrowing is more pronounced compared to patients with stage 2 CKD. Whether the novel observation of difference in arteriolar caliber between zones B and C in stage 2 CKD could serve as an early marker of CKD progression warrants further investigation.
患有进展性慢性肾脏病 (CKD) 的患者比进展为终末期肾病的患者更容易发生心脑血管事件。作者探讨了视网膜微血管的直径是否与肾功能损害的程度以及标准和扩展视盘之间存在差异，并可能作为该高度脆弱患者群体风险分层的简单附加工具。作者使用数字视网膜成像分析了高血压患者中不同视网膜区域（区域 B 和 C）的中心视网膜小动脉和小静脉等效直径（CRAE、CRVE），这些患者患有 2 期（n=66）或 3 期 CKD（n=30）。结果根据年龄、性别、HbA1c 和 24 小时舒张压进行了调整。2 期和 3 期 CKD 患者的平均 eGFR 分别为 77.7±8.9 和 48.8±7.9 ml/min/1.73 m。与 2 期 CKD 患者相比，3 期 CKD 患者的 CRAE-B（141.1±21.4 对 130.5±18.9 µm，p=0.030）和 CRAE-C（137.4±19.4 对 129.2±18.2 µm，p=0.049）以及 CRVE-B（220.8±33.0 对 206.0±28.4 µm，p=0.004）和 CRVE-C（215.9±33.0 对 201.2±25.1 µm，p=0.003）的直径明显更低。在 2 期 CKD 患者中，CRAE-B 高于 CRAE-C（141.1±21.4 对 137.4±19.4 µm，p<0.001）。相比之下，在 3 期 CKD 患者中没有发现这种差异。两个视网膜区域的 CRAE 与整个队列的 eGFR 相关。在 3 期 CKD 患者中，与 2 期 CKD 患者相比，视网膜变窄更为明显。2 期 CKD 中 B 区和 C 区之间小动脉直径差异是否可以作为 CKD 进展的早期标志物，尚需进一步研究。
