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Itika Garg, Margaret Duich, Chibuike Uwakwe, Edward S Lu, Karen Michelle Wai, Ying Cui, Rongrong Le, Rebecca Zeng, Raviv Katz, Ying Zhu, Leo A Kim, David M Wu, Nimesh A. Patel, Deeba Husain, Demetrios G. Vavvas, John B Miller; Widefield Swept-Source OCT Angiography (WF SS-OCTA) Vascular Metrics as Biomarkers for Renal Function in Diabetes Mellitus (DM) Patients. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2929 – F0082.
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Microvascular complications of DM (retinopathy, nephropathy and neuropathy) are closely interrelated and are an important cause of patient morbidity and mortality. We aim to evaluate the relationship between WF SS-OCTA quantitative metrics and the presence of albuminuria and serum creatinine in DM patients.
In this cross-sectional observational study between January 2019 and April 2021, 380 eyes of 234 patients were imaged on 100kHz WF SS-OCTA using 12x12mm angiogram centered on fovea. The ARI Network (Zeiss Portal) was used to calculate vessel density (VD), vessel skeletonized density (VSD), foveal avascular zone area, circularity, and perimeter; and ImageJ for non-perfusion area (NPA), Figure 1. We recorded glycosylated hemoglobin (HbA1c), serum urea, creatinine and urine albumin to creatinine ratio (ACR) within one year of imaging.
The median patient age was 58.5 (50-65) years and 125 (53.4%) were males. Subjects had a median HbA1c 8.1 (7-9.3) %, median creatinine 0.98 (0.80-1.33) mg/dL and 111 (47.4%) patients had albuminuria (urine ACR >30mg/g). Using serum creatinine, estimated glomerular filtration rate (eGFR) was calculated, and 74 (31.6%) patients had chronic diabetic kidney disease (CDKD) i.e., eGFR <60mL/min/1.73m2 (Figure 2). Using mixed effects multiple logistic regression model adjusting for age, smoking status, HbA1c, mean arterial blood pressure and duration of diabetes; NPA (Odd’s ratio (OR)=1.14, 1.03-1.27; p=0.02) and whole retina VSD (OR=0.26, 0.08-0.10; p=0.02) were significantly associated with the presence of albuminuria. None of the OCTA metrics were significantly associated with serum creatinine. Also, NPA (OR=1.11, 1.00-1.23, p=0.047) and superficial VSD (OR=0.61, 0.37-0.99, p=0.047) were significant predictors for the presence of CDKD.
Herein, we see that NPA can serve as a potential imaging biomarker associated with deteriorating renal function (presence of albuminuria and CDKD). Due to OCTA having high-resolution and being depth resolved, quantitative OCTA metrics can leverage the changes at the retinal capillary level in patients with kidney damage. Hence, this safe non-invasive device can be potentially useful for diagnosis and early management of various microvascular complications of DM.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
WF SS-OCTA metrics analyzed
Boxplots comparing WF SS-OCTA metrics in DM patients with and without nephropathy
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