Retinal and choroidal vasculature changes associated with chronic kidney disease

Abstract

Purpose: Retinal and choroidal microvascular changes can be related to renal impairment in hypertension and chronic kidney disease (CKD). The study examines the association between retino-choroidal parameters and renal impairment in hypertensive, non diabetic patients. Methods: This is a cross-sectional study on Caucasian patients with systemic arterial hypertension with different levels of renal function. All subjects were studied by blood chemistry, urine examination, microalbuminuria and blood pressure. Complete eye examination was completed with SS-OCT and OCTA scans of macular region. Patients were divided in groups: LowGFR and HighGFR, CKD- and CKD+, according to the value of glomerular filtrate (GFR) and albuminuria. LowGFR and CKD+ groups included patients with clinical kidney impairment. Results: 120 eyes of 120 hypertensive patients were evaluated. Mean retinal thickness was thinner in CKD+ versus CKD- group (p<0.009). LowGFR and CKD+ groups showed thinner choroidal values than HighGFR (p<0.02) and CKD- (p<0.001) groups. OCTA showed lower density in LowGFR than in HighGFR group (p<0.001), and in CKD+ versus CKD- group (p<0.001). Albuminuria was inversely related to choroidal and retinal thickness measures (p<0.001) and to the indices of superficial parafoveal (p<0.05) and foveal (p<0.05) vascular density. Conclusions: CKD is associated with retinal thinning, eGFR and decreasing renal function with progressive reduction of choroidal and retinal vascular density. SS-OCT and OCTA documented close association between CKD and reduction of both choroidal thickness and paracentral retinal vascular density in hypertensive patients.