Yong Meng Hsien, Ong Ming Yean, Tan Kuan Sze, Hussein Siti Husna, Mohd Zain Ayesha, Mohd Rozita, Mustafar Ruslinda, Wan Abdul Halim Wan Haslina
Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Front Cell Neurosci. 2022 Mar 11;16:766619. doi: 10.3389/fncel.2022.766619. eCollection 2022.
Chronic kidney disease (CKD) is a major public health issue because of the rising number of patients with the risk of progression to end-stage renal disease. The retinal micro-vasculatures provide a unique window to assess systemic microcirculation. Optical Coherence Tomography Angiography (OCTA) parameters may provide a non-invasive method for systemic correlation. This research aims to compare the association of OCTA parameters in different causes of CKD.
This is a single-center cross-sectional study on patients with CKD at the Universiti Kebangsaan Malaysia Medical Centre over 2 years. Patients with CKD were divided into three groups: DM group (diabetic CKD), HPT group (hypertensive CKD), and AG group (autoimmune-related glomerulonephritis CKD). The OCTA parameters, namely, the foveal avascular zone (FAZ), vascular density (VD), perfusion density (PD), and macular volume (MV), were measured and recorded using OCTA. Blood and urine analyses were taken as the patient's CKD profile. The demographic data, the OCTA parameters and the CKD profiles, were analyzed using SPSS version 23.
The right eyes of 232 patients were included. The median age of the control and CKD subjects were 36 and 61 years old respectively. The proportion of the subjects under the control, diabetes mellitus (DM), HPT, and AG group were 30.6, 53.4, 5.6, and 10.4% respectively. There was no significant difference in FAZ, but there is a significant difference in the VD, PD, and MV between the control and CKD groups. There was a statistically significant difference between the three different causes of CKD in VD and PD ( < 0.001, = 0.001, respectively). When compared with the control group for VD and PD, there were significant differences between the DM-control group ( < 0.001, < 0.001) even when the age variable was considered, but no significant difference when comparing the HPT-control and the AG-control. There was a significant correlation between age, FBS, and HbA1c with VD and PD. There was no significant association between CKD profile and FAZ.
Our study showed the meaningful reduction of VD and PD in patients with diabetes and CKD. However, the use of OCTA to screen or predict CKD in patients living with diabetes mellitus, hypertension, or autoimmune nephritis was not shown to be useful.
慢性肾脏病（CKD）是一个重大的公共卫生问题，因为进展为终末期肾病风险的患者数量不断增加。视网膜微血管为评估全身微循环提供了一个独特的窗口。光学相干断层扫描血管造影（OCTA）参数可能提供一种用于全身相关性分析的非侵入性方法。本研究旨在比较不同病因的CKD中OCTA参数的相关性。
这是一项在马来西亚国民大学医学中心对CKD患者进行的为期2年的单中心横断面研究。CKD患者被分为三组：糖尿病组（糖尿病性CKD）、高血压组（高血压性CKD）和自身免疫相关肾小球肾炎组（自身免疫相关肾小球肾炎性CKD）。使用OCTA测量并记录OCTA参数，即中心凹无血管区（FAZ）、血管密度（VD）、灌注密度（PD）和黄斑体积（MV）。采集血液和尿液分析作为患者的CKD资料。使用SPSS 23版对人口统计学数据、OCTA参数和CKD资料进行分析。
纳入232例患者的右眼。对照组和CKD受试者的中位年龄分别为36岁和61岁。对照组、糖尿病（DM）组、高血压组和自身免疫相关肾小球肾炎组受试者的比例分别为30.6%、53.4%、5.6%和10.4%。FAZ无显著差异，但对照组和CKD组之间的VD、PD和MV有显著差异。三种不同病因的CKD在VD和PD方面存在统计学显著差异（分别为<0.001，=0.001）。与对照组比较VD和PD时，即使考虑年龄变量，DM对照组之间也存在显著差异（<0.001，<0.001），但比较高血压对照组和自身免疫相关肾小球肾炎对照组时无显著差异。年龄、空腹血糖（FBS）和糖化血红蛋白（HbA1c）与VD和PD之间存在显著相关性。CKD资料与FAZ之间无显著关联。
我们的研究表明糖尿病合并CKD患者的VD和PD有显著降低。然而，未显示使用OCTA对糖尿病、高血压或自身免疫性肾炎患者进行CKD筛查或预测是有用的。
