Retinal microvasculature characteristics for individualized risk stratification of end-stage renal disease

Abstract

Purpose : Patients with end-stage renal disease (ESRD) are characterized by high mortality rate and retinal microvasculature may serve as a noninvasive prognostic marker. This study investigated the characteristics of retinal microvasculature in ESRD patients and predicts their prognosis by optical coherence tomography angiography (OCTA).

Methods : This was a prospective cohort study. Patients with ESRD treated with hemodialysis were included and measured by swept-source OCTA at the baseline, then followed-up for 2-year with clinical examination and OCTA. The estimated vessel density (VD) of deep capillary plexus (DCP) in retina were analyzed. Linear regression was utilized to compare OCTA metrics among groups after adjusting for confounding factors. And the prognositc prediction value of OCTA metrics was assessed using Kaplan-Meier and Cox proportional hazard regression (CPH) models.

Results : A total 161 eyes from 161 patients with ESRD were included (mean age: 53.94 ± 13.93 years; 42.2% women). The 2-year all-cause mortality was 13.7% (N = 22). DCP emerged as a strong independent predictor for all-cause mortality. After adjusting for age and sex, VD in DCP exhibited significant decrease in deceased patients compared with living patiens (33.51 ± 3.81 vs 35.38 ± 3.87, p = 0.024). And Kaplan-Meier analysis revealed significant differences for all-cause mortality between DCP tertile groups (p = 0.007). Combining OCTA and clinical data, a CPH model was developed to predict 2-year all-cause mortality with C-index of 0.913 (standard deviation = 0.058). The model was discriminative in stratifying patients into high- and low-risk subgroups (p < 0.001). VD in inferior-nasal area of DCP was found to be significantly associated with all-cause mortality (adjusted hazard ratio = 0.921, 95% confidence interval: 0.861–0.985; p = 0.017).

Conclusions : Our study identified characteristic retinal microvascular changes in DCP as strong and independent predictor of all-cause mortality for hemodialysis patients with ESRD. The development of effective models for individualized risk stratification based on OCTA metrics can provide additional value to the prediction of ESRD prognosis.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.