Application of optical coherence tomography angiography in clinical evaluation of chronic kidney disease

doi:10.11958/20231571

Abstract

Abstract:

Chronic kidney disease (CKD) is a common chronic disease. There is homology between retina and kidneys. Diabetic retinopathy and retinal neurovascular injury both reveal common pathophysiological features of ocular retina and kidney. Optical coherence tomography angiography (OCTA) detects chorioretinal microcirculation with near-histological resolution. Changes in microvascular structure and function can promote the development of hypertension, diabetes, CKD and related cardiovascular disease (CVD). The examination of fundus nerve microvessels by OCTA in patients with CKD is helpful to the identification of high-risk groups, and provides a new perspective for the assessment of disease progression and CVD risk prediction of patients with CKD. The combination of the deep learning will further expand this aspect of research and become the forefront of future development.

Key words: renal insufficiency, chronic, tomography, optical coherence, retinal vessels, diabetic retinopathy, cardiovascular diseases

CLC Number:

R770.4，R774

References 52

[1]	WANG L, XU X, ZHANG M, et al. Prevalence of chronic kidney disease in China:Results from the Sixth China Chronic Disease and Risk Factor Surveillance[J]. JAMA Intern Med, 2023, 183(4):298-310. doi:10.1001/jamainternmed.2022.6817.
[2]	上海市肾内科临床质量控制中心专家组. 慢性肾脏病早期筛查,诊断及防治指南(2022年版)[J]. 中华肾脏病杂志, 2022, 38(5):453-464.
	Expert Group on Kidney Clinical Quality Control Center in Shanghai. Guidelines for early screening,diagnosis,prevention and treatment of chronic kidney disease(2022 Edition)[J]. Chinese Journal of Nephrology, 2022, 38(5):453-464. doi:10.3760/cma.j.cn441217-20210819-00067.
[3]	FURSOVA A Z, DERBENEVA A S, VASILYEVA M V, et al. Structural and microvascular changes in the retina and choroid in patients with chronic kidney disease[J]. Vestn Oftalmol, 2021, 137(6):99-108. doi:10.17116/oftalma202113706199.
[4]	FURSOVA A Z, DERBENEVA A S, VASILYEVA M A, et al. Development,clinical manifestations and diagnosis of retinal changes in chronic kidney disease[J]. Vestn Oftalmol, 2021, 137(1):107-114. doi:10.17116/oftalma2021137011107.
[5]	HUANG Y, YUAN Y, SETH I, et al. Optic nerve head capillary network quantified by optical coherence tomography angiography and decline of renal function in type 2 diabetes:a three-year prospective study[J]. Am J Ophthalmol, 2023, 253:96-105. doi:10.1016/j.ajo.2023.04.003.
[6]	SPAIDE R F, FUJIMOTO J G, WAHEED N K, et al. Optical coherence tomography angiography[J]. Prog Retin Eye Res, 2018, 64:1-55. doi:10.1016/j.preteyeres.2017.11.003.
[7]	WANG A, QI W, GAO T, et al. Molecular contrast optical coherence tomography and its applications in medicine[J]. Int J Mol Sci, 2022, 23(6):3038. doi:10.3390/ijms23063038.
[8]	FARRAH T E, DHILLON B, KEANE P A, et al. The eye,the kidney,and cardiovascular disease: old concepts, better tools, and new horizons[J]. Kidney Int, 2020, 98(2):323-342. doi:10.1016/j.kint.2020.01.039.
[9]	LI X, XIE J, ZHANG L, et al. Identifying microvascular and neural parameters related to the severity of diabetic retinopathy using optical coherence tomography angiography[J]. Invest Ophthalmol Vis Sci, 2020, 61(5):39. doi:10.1167/iovs.61.5.39.
[10]	WU I W, SUN C C, LEE C C, et al. Retinal neurovascular changes in chronic kidney disease[J]. Acta Ophthalmol, 2020, 98(7):e848-e855. doi:10.1111/aos.14395.
[11]	DOUGLAS V P, DOUGLAS K, TORUN N. Optical coherence tomography angiography in neuro-ophthalmology[J]. Curr Opin Ophthalmol, 2023, 34(4):354-360. doi:10.1097/ICU.0000000000000955.
[12]	ELTANAHY A M, FRANCO C, JEYARAJ P, et al. Ex vivo ocular perfusion model to study vascular physiology in the mouse eye[J]. Exp Eye Res, 2023, 233:109543. doi:10.1016/j.exer.2023.109543.
[13]	MURALI A, KRISHNAKUMAR S, SUBRAMANIAN A, et al. Bruch's membrane pathology:a mechanistic perspective[J]. Eur J Ophthalmol, 2020, 30(6):1195-1206. doi:10.1177/1120672120919337.
[14]	CICINELLI M V, RITTER M, TAUSIF H, et al. Characterization of choriocapillaris and choroidal abnormalities in Alport Syndrome[J]. Transl Vis Sci Technol, 2022, 11(3):23. doi:10.1167/tvst.11.3.23.
[15]	ZHU V, HUANG T, WANG D, et al. Ocular manifestations of the genetic causes of focal and segmental glomerulosclerosis[J]. Pediatr Nephrol, 2023. doi:10.1007/s00467-023-06073-y. [Epub ahead of print].
[16]	OSHITARI T. Advanced glycation end-products and diabetic neuropathy of the retina[J]. Int J Mol Sci, 2023, 24(3):2927. doi:10.3390/ijms24032927.
[17]	ZENG X, HU Y, CHEN Y, et al. Retinal neurovascular impairment in non-diabetic and non-dialytic chronic kidney disease patients[J]. Front Neurosci, 2021, 15:703898. doi:10.3389/fnins.2021.703898.
[18]	KASUMOVIC A, MATOC I, REBIC D, et al. Assessment of retinal microangiopathy in chronic kidney disease patients[J]. Med Arch, 2020, 74(3):191-194. doi:10.5455/medarh.2020.74.191-194.
[19]	GRUNWALD J E, PISTILLI M, YING G S, et al. Association between progression of retinopathy and concurrent progression of kidney disease:Findings from the Chronic Renal Insufficiency Cohort(CRIC)Study[J]. JAMA Ophthalmol, 2019, 137(7):767-774. doi:10.1001/jamaophthalmol.2019.1052.
[20]	MARX N, FEDERICI M, SCHüTT K, et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes[J]. Eur Heart J,2023, 44(39):4043-4140. doi:10.1093/eurheartj/ehad192.
[21]	中华医学会糖尿病学分会微血管并发症学组. 中国糖尿病肾脏病防治指南(2021年版)[J]. 中华糖尿病杂志, 2021, 13(8):762-784.
	Microvascular Complications Group of Chinese Diabetes Society. Clinical guideline for the prevention and treatment of diabetic kidney disease in China(2021 edition)[J]. Chinese Journal of Diabetes, 2021, 13(8):762-784. doi:10.3760/cma.j.cn115791-20210706-00369.
[22]	American Diabetes Association Professional Practice Committee. 3. Prevention or Delay of Type 2 Diabetes and Associated Comorbidities:Standards of Medical Care in Diabetes-2022[J]. Diabetes Care, 2022, 45(Suppl 1):S39-S45. doi:10.2337/dc22-S003.
[23]	TU X, LUO N, LV Y, et al. Prognostic evaluation model of diabetic nephropathy patients[J]. Ann Palliat Med, 2021, 10(6):6867-6872. doi:10.21037/apm-21-1454.
[24]	SHI S, GAO L, ZHANG J, et al. The automatic detection of diabetic kidney disease from retinal vascular parameters combined with clinical variables using artificial intelligence in type-2 diabetes patients[J]. BMC Med Inform Decis Mak, 2023, 23(1):241. doi:10.1186/s12911-023-02343-9.
[25]	SUN Z, TANG F, WONG R, et al. OCT Angiography metrics predict progression of diabetic retinopathy and development of diabetic macular edema:a prospective study[J]. Ophthalmology, 2019, 126(12):1675-1684. doi:10.1016/j.ophtha.2019.06.016.
[26]	CHEUNG C Y, TANG F, NG D S, et al. The relationship of quantitative retinal capillary network to kidney function in type 2 diabetes[J]. Am J Kidney Dis, 2018, 71(6):916-918. doi:10.1053/j.ajkd.2017.12.010.
[27]	WANG W, HE M, GONG X, et al. Association of renal function with retinal vessel density in patients with type 2 diabetes by using swept-source optical coherence tomographic angiography[J]. Br J Ophthalmol, 2020, 104(12):1768-1773. doi:10.1136/bjophthalmol-2019-315450.
[28]	ZHUANG X, CAO D, ZENG Y, et al. Associations between retinal microvasculature/microstructure and renal function in type 2 diabetes patients with early chronic kidney disease[J]. Diabetes Res Clin Pract, 2020, 168:108373. doi:10.1016/j.diabres.2020.108373.
[29]	AMEER O Z. Hypertension in chronic kidney disease:What lies behind the scene[J]. Front Pharmacol, 2022, 13:949260. doi:10.3389/fphar.2022.949260.
[30]	CHUA J, CHIN C, HONG J, et al. Impact of hypertension on retinal capillary microvasculature using optical coherence tomographic angiography[J]. J Hypertens, 2019, 37(3):572-580. doi:10.1097/HJH.0000000000001916.
[31]	MULÈ G, VADALà M, LA BLASCA T, et al. Association between early-stage chronic kidney disease and reduced choroidal thickness in essential hypertensive patients[J]. Hypertens Res, 2019, 42(7):990-1000. doi:10.1038/s41440-018-0195-1.
[32]	VADALÀ M, CASTELLUCCI M, GUARRASI G, et al. Retinal and choroidal vasculature changes associated with chronic kidney disease[J]. Graefes Arch Clin Exp Ophthalmol, 2019, 257(8):1687-1698. doi:10.1007/s00417-019-04358-3.
[33]	CHUA J, LE T T, TAN B, et al. Choriocapillaris microvasculature dysfunction in systemic hypertension[J]. Sci Rep, 2021, 11(1):4603. doi:10.1038/s41598-021-84136-6.
[34]	BASIONY A I, ATTA S N, DEWIDAR N M, et al. Association of chorioretinal thickness with chronic kidney disease[J]. BMC Ophthalmol, 2023, 23(1):55. doi:10.1186/s12886-023-02802-x.
[35]	SHIN Y U, LEE S E, KANG M H, et al. Evaluation of changes in choroidal thickness and the choroidal vascularity index after hemodialysis in patients with end-stage renal disease by using swept-source optical coherence tomography[J]. Medicine(Baltimore), 2019, 98(18):e15421. doi:10.1097/MD.0000000000015421.
[36]	HWANG H, CHAE J B, KIM J Y, et al. Changes in optical coherence tomography findings in patients with chronic renal failure undergoing dialysis for the first time[J]. Retina, 2019, 39(12):2360-2368. doi:10.1097/IAE.0000000000002312.
[37]	NAKANO H, HASEBE H, MURAKAMI K, et al. Choroid structure analysis following initiation of hemodialysis by using swept-source optical coherence tomography in patients with and without diabetes[J]. PLoS One, 2020, 15(9):e0239072. doi:10.1371/journal.pone.0239072.
[38]	ZHANG J F, WISEMAN S, VALDÉS-HERNÁNDEZ M C, et al. The application of optical coherence tomography angiography in cerebral small vessel disease, ischemic stroke,and dementia:a systematic review[J]. Front Neurol, 2020, 11:1009. doi:10.3389/fneur.2020.01009.
[39]	FINDLAY M D, DAWSON J, DICKIE D A, et al. Investigating the relationship between cerebral blood flow and cognitive function in hemodialysis patients[J]. J Am Soc Nephrol, 2019, 30(1):147-158. doi:10.1681/ASN.2018050462.
[40]	HUANG H. Pericyte-Endothelial interactions in the retinal microvasculature[J]. Int J Mol Sci, 2020, 21(19):7413. doi:10.3390/ijms21197413.
[41]	STEHOUWER C. Microvascular dysfunction and hyperglycemia:a vicious cycle with widespread consequences[J]. Diabetes, 2018, 67(9):1729-1741. doi:10.2337/dbi17-0044.
[42]	NÄGELE M P, BARTHELMES J, LUDOVICI V, et al. Retinal microvascular dysfunction in heart failure[J]. Eur Heart J, 2018, 39(1):47-56. doi:10.1093/eurheartj/ehx565.
[43]	CIMMINO G, NATALE F, ALFIERI R, et al. Non-conventional risk factors:"Fact" or "Fake" in cardiovascular disease prevention?[J]. Biomedicines, 2023, 11(9):2353. doi:10.3390/biomedicines11092353.
[44]	LEMMENS S, DEVULDER A, VAN KEER K, et al. Systematic review on fractal dimension of the retinal vasculature in neurodegeneration and stroke:assessment of a potential biomarker[J]. Front Neurosci, 2020, 14:16. doi:10.3389/fnins.2020.00016.
[45]	GRUNWALD J E, PISTILLI M, YING G S, et al. Progression of retinopathy and incidence of cardiovascular disease:findings from the chronic renal insufficiency cohort study[J]. Br J Ophthalmol, 2021, 105(2):246-252. doi:10.1136/bjophthalmol-2019-315333.
[46]	ARNOULD L, GUENANCIA C, AZEMAR A, et al. The EYE-MI pilot study:a prospective acute coronary syndrome cohort evaluated with retinal optical coherence tomography angiography[J]. Invest Ophthalmol Vis Sci, 2018, 59(10):4299-4306. doi:10.1167/iovs.18-24090.
[47]	LIEW G, XIE J, NGUYEN H, et al. Hypertensive retinopathy and cardiovascular disease risk: 6 population-based cohorts Meta-analysis[J]. Int J Cardiol Cardiovasc Risk Prev, 2023, 17:200180. doi:10.1016/j.ijcrp.2023.200180.
[48]	OSTRIN L A, HARB E, NICKLA D L, et al. IMI-The dynamic choroid:new insights,challenges,and potential significance for human myopia[J]. Invest Ophthalmol Vis Sci, 2023, 64(6):4. doi:10.1167/iovs.64.6.4.
[49]	KHALILIPUR E, MAHDIZAD Z, MOLAZADEH N, et al. Microvascular and structural analysis of the retina and choroid in heart failure patients with reduced ejection fraction[J]. Sci Rep, 2023, 13(1):5467. doi:10.1038/s41598-023-32751-w.
[50]	WANG J, JIANG J, ZHANG Y, et al. Retinal and choroidal vascular changes in coronary heart disease: an optical coherence tomography angiography study[J]. Biomed Opt Express, 2019, 10(4):1532-1544. doi:10.1364/BOE.10.001532.
[51]	JOO Y S, RIM T H, KOH H B, et al. Non-invasive chronic kidney disease risk stratification tool derived from retina-based deep learning and clinical factors[J]. NPJ Digit Med, 2023, 6(1):114. doi:10.1038/s41746-023-00860-5.
[52]	RUDNICKA A R, WELIKALA R, BARMAN S, et al. Artificial intelligence-enabled retinal vasculometry for prediction of circulatory mortality, myocardial infarction and stroke[J]. Br J Ophthalmol, 2022, 106(12):1722-1729. doi:10.1136/bjo-2022-321842.