Abstract
Purpose :
To evaluate optical coherence tomography angiography (OCTA) parameters of the retinal and choriocapillaris vasculature in predicting the progression of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (DM).
Methods :
A prospective cohort study. We included 154 patients who attended a tertiary eye clinic and followed them for 1 year. At baseline, perfusion density (PD), vessel density (VD), foveal avascular zone (FAZ) of superficial vascular complex (SVC) and deep vascular complex (DVC), and choriocapillaris flow void density, size, and number of the worse eye were evaluated on 3 x3 mm2 OCTA scans (Plex-Elite, Carl Zeiss Meditec, Dublin, CA, USA). CKD progression was defined by a decrease in estimated glomerular filtration rate and an increase in albuminuria based on Kidney Disease Improving Global Outcomes (KDIGO) risk category (low, moderate, high, and very high). A change from one risk category to a higher risk category is regarded as CKD progression. Binary logistic regression was used to evaluate associations between baseline demographic, clinical characteristics, comorbidities, urinary, haematology, and OCTA parameters and CKD progression, adjusted for potential confounders. The area under the receiver operating characteristic (AUC) was assessed to measure the accuracy of systemic risk factors, and the combination of systemic risk factors and OCTA parameters in predicting CKD progression.
Results :
Twenty-one (13.6%) patients had CKD progression over one-year follow-up, of whom 14 (9.1%) progressed from low-to-moderately increased risk, 8 (5.2%) from moderately increased risk-to-high risk, and 10 (6.5%) from high-to-very high risk. CKD progression was associated with younger age (p = 0.025), early onset of DM (p = 0.033), height (p = 0.025), weight (p = 0.008), total cholesterol (p = 0.047), HDL cholesterol (p = 0.015), FAZ area in the SVC (p = 0.044), and CC flow void number (p = 0.047). In the multivariate analysis which only included systemic risk factors, the AUC was 0.819. After adjusting with the FAZ area in the SVC, and CC flow void number, the AUC increased to 0.940.
Conclusions :
Our longitudinal study showed that, in addition to the systemic risk factors, OCTA changes in the retina and choriocapillaris improved the prediction of CKD progression in type 2 DM.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.