Tom Elysse S, Saraf Steven S, Wang FuPeng, Zhang Qinqin, Vangipuram Gautam, Limonte Christine P, de Boer Ian H, Wang Ruikang K, Rezaei Kasra A
Department of Ophthalmology, University of Washington, Seattle, WA, USA.
Department of Bioengineering, University of Washington, Seattle, WA, USA.
J Ophthalmol. 2020 Nov 30;2020:2473949. doi: 10.1155/2020/2473949. eCollection 2020.
Diabetic retinopathy and kidney disease share underlying mechanisms of microvascular damage and are often comorbid in people with diabetes. We evaluated whether there is a relationship between retinal capillary perfusion as measured by swept-source optical coherence tomography angiography and estimated glomerular filtration rate (eGFR) and albuminuria in patients with diabetes and chronic kidney disease (CKD).
A cross-sectional pilot study was conducted at the University of Washington among a subset of participants with diabetes and CKD participating in a larger cohort study. Participants were excluded if they were known to have kidney disease from conditions other than diabetes. Ten participants (11 eyes) were included. Retinal nonperfusion (RNP) and vessel density (VD) were measured by swept-source optical coherence tomography angiography in 30° and 60° field of view (FOV) regions centered at the fovea. Correlations of RNP and VD with eGFR and albuminuria were analyzed.
Participants had a mean age of 72 years, hemoglobin A1c of 8.1%, eGFR of 45 mL/min/1.73 m, and urine albumin-to-creatinine ratio of 162 mg/g. Mean (SD) RNP was 6.6% (4.2%) and 16.9% (7.7%) in 30° and 60° FOV regions, respectively. eGFR was negatively correlated to RNP in both the 30° and 60° FOV regions ( = -0.69, =0.004, and = -0.46, =0.057, respectively), and correlations were stronger among a subset of 7 participants with evidence of diabetic retinopathy on exam and fundus photos. The estimated GFR was not significantly correlated with vessel density. Urine albumin-to-creatinine ratio was not significantly correlated with RNP or VD.
Our proof-of-concept study showed that lower eGFR was significantly correlated with retinal nonperfusion in participants with diabetes and CKD. Advanced retinal imaging may enhance the noninvasive evaluation of kidney function in diabetes.
糖尿病视网膜病变和肾脏疾病具有微血管损伤的共同潜在机制，且在糖尿病患者中常合并存在。我们评估了在糖尿病和慢性肾脏病（CKD）患者中，通过扫频光学相干断层扫描血管造影术测量的视网膜毛细血管灌注与估计肾小球滤过率（eGFR）及蛋白尿之间是否存在关联。
在华盛顿大学对参与一项更大队列研究的糖尿病和CKD患者亚组进行了一项横断面试点研究。如果已知患者患有除糖尿病以外的其他肾脏疾病，则将其排除。纳入了10名参与者（11只眼）。通过扫频光学相干断层扫描血管造影术在以黄斑为中心的30°和60°视野（FOV）区域测量视网膜无灌注（RNP）和血管密度（VD）。分析了RNP和VD与eGFR及蛋白尿的相关性。
参与者的平均年龄为72岁，糖化血红蛋白为8.1%，eGFR为45 mL/min/1.73 m²，尿白蛋白与肌酐比值为162 mg/g。在30°和60° FOV区域，平均（标准差）RNP分别为6.6%（4.2%）和16.9%（7.7%）。在30°和60° FOV区域，eGFR与RNP均呈负相关（分别为r = -0.69，P = 0.004和r = -0.46，P = 0.057），并且在7名经检查和眼底照片有糖尿病视网膜病变证据的参与者亚组中相关性更强。估计肾小球滤过率与血管密度无显著相关性。尿白蛋白与肌酐比值与RNP或VD无显著相关性。
我们的概念验证研究表明，在糖尿病和CKD患者中，较低的eGFR与视网膜无灌注显著相关。先进的视网膜成像可能会增强对糖尿病患者肾功能的无创评估。
