Aims To investigate the relationship between retinal vessel density and renal function in patients with diabetes mellitus (DM) using non-invasive optical coherence tomographic angiography (OCTA).
Methods This prospective cross-sectional study recruited ocular-treatment-naïve patients with DM registered in the community of Guangzhou, China. The retinal vessel density of the superficial capillary plexus in the macula was obtained by using swept-source OCTA imaging. The Xiangya equation was used to calculate the estimated glomerular filtrate rate (eGFR). Participants were divided into the following groups by eGFR: no chronic kidney disease (non-CKD), mild CKD and moderate-to-severe CKD (MS-CKD).
Results A total of 874 patients with DM (874 eyes), with a mean age of 64.8±7.1 years, were included in the final analysis. The vessel density was significantly lower in patients with CKD than in non-CKD patients in a dose–response pattern, with a parafoveal vessel density of 49.1%±2.1% in non-CKD, 48.4%±1.9% in mild CKD and 47.2%±1.7% in MS-CKD (p<0.001). The sparser retinal capillaries were related to lower eGFR (β=0.037; 95% CI 0.025 to 0.049; p<0.001) and higher microalbuminuria (β = –0.023; 95% CI –0.039 to –0.008; p=0.002). The eGRF was independently associated with parafoveal vessel density (β=0.029; 95% CI 0.016 to 0.042; p<0.001), even after adjusting for other factors.
Conclusion Retinal vessel density decreased with renal function impairment, underlining the potential value of OCTA to detect early microvascular damage in the kidney in patients with diabetes.
- public health
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Contributors WW and WH had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: WW, WL, MH and WH. Acquisition, analysis or interpretation of data: XG, LW, JM, YL, KX and WL. Drafting of the manuscript: WW and MH. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: WW. Obtained funding: WH. Administrative, technical or material support: MH and WW. Study supervision: MH.
Funding This study was supported by the National Natural Science Foundation of China (81570843; 81530028; 81721003), the Guangdong Province Science & Technology Plan (2014B020228002).
Disclaimer The funding organisations had no role in the design or conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study protocol was approved by the Ethical Committee of the Zhongshan Ophthalmic Centre (2017KYPJ094). The study was implemented in compliance with the Declaration of Helsinki.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.