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Yaman Kula A, Deniz Ç, Özdemir Gültekin T, Altinisik M, Asil T. Evaluation of Cerebral Vasomotor Reactivity by Transcranial Doppler Ultrasound in Patients with Diabetic Retinopathy. Neuroophthalmology 2023; 47:199-207. [PMID: 37434670 PMCID: PMC10332244 DOI: 10.1080/01658107.2023.2212754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 07/13/2023] Open
Abstract
The aim of this study was to assess the correlation between cerebral vasomotor reactivity (CVR) and the grade of diabetic retinopathy. A total of 43 diabetic patients with matched severity of diabetic retinopathy between their right and left eyes were included in this study. Diabetic retinopathy was graded in three groups. Right and left middle cerebral artery CVR was assessed by the breath-holding index (BHI) using transcranial Doppler ultrasound (TCD). The mean age of the patients was 56.51 ± 9.34 years with a mean duration of having diabetes mellitus of 14.49 ± 8.06 years. Diabetic retinopathy was graded as mild, moderately severe, and severe in 27.9%, 34.9%, and 37.2% of the patients, respectively. The grade of diabetic retinopathy was associated with the HbA1c level (p < .049), microalbuminuria (p < .024), and BHI (p = .001). In patients with severe diabetic retinopathy, the right-sided BHI was significantly lower as compared to those with mild or moderately severe retinopathy (p = .001 and p = .008, respectively). The left-sided BHI value in patients with severe diabetic retinopathy was significantly lower as compared to those with mild or moderately severe retinopathy (p = .001 and p = .012, respectively). In subjects with moderately severe diabetic retinopathy, both-sided BHI was significantly reduced compared to those with mild retinopathy (p = .001). Our results indicate that the grade of diabetic retinopathy was associated with impaired CVR.
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Affiliation(s)
- Aslı Yaman Kula
- Department of Neurology, Bezmialem Vakif University Hospital, Istanbul, Turkey
| | - Çiğdem Deniz
- Department of Neurology, Namik Kemal University Hospital, Tekirdag, Turkey
| | | | - Muhammed Altinisik
- Department of Ophthalmology, Celal Bayar University Hospital, Manisa, Turkey
| | - Talip Asil
- Department of Neurology, Memorial Hizmet Hospital, Istanbul, Turkey
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Wagner SK, Cortina-Borja M, Silverstein SM, Zhou Y, Romero-Bascones D, Struyven RR, Trucco E, Mookiah MRK, MacGillivray T, Hogg S, Liu T, Williamson DJ, Pontikos N, Patel PJ, Balaskas K, Alexander DC, Stuart KV, Khawaja AP, Denniston AK, Rahi JS, Petzold A, Keane PA. Association Between Retinal Features From Multimodal Imaging and Schizophrenia. JAMA Psychiatry 2023; 80:478-487. [PMID: 36947045 PMCID: PMC10034669 DOI: 10.1001/jamapsychiatry.2023.0171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/23/2023] [Indexed: 03/23/2023]
Abstract
Importance The potential association of schizophrenia with distinct retinal changes is of clinical interest but has been challenging to investigate because of a lack of sufficiently large and detailed cohorts. Objective To investigate the association between retinal biomarkers from multimodal imaging (oculomics) and schizophrenia in a large real-world population. Design, Setting, and Participants This cross-sectional analysis used data from a retrospective cohort of 154 830 patients 40 years and older from the AlzEye study, which linked ophthalmic data with hospital admission data across England. Patients attended Moorfields Eye Hospital, a secondary care ophthalmic hospital with a principal central site, 4 district hubs, and 5 satellite clinics in and around London, United Kingdom, and had retinal imaging during the study period (January 2008 and April 2018). Data were analyzed from January 2022 to July 2022. Main Outcomes and Measures Retinovascular and optic nerve indices were computed from color fundus photography. Macular retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (mGC-IPL) thicknesses were extracted from optical coherence tomography. Linear mixed-effects models were used to examine the association between schizophrenia and retinal biomarkers. Results A total of 485 individuals (747 eyes) with schizophrenia (mean [SD] age, 64.9 years [12.2]; 258 [53.2%] female) and 100 931 individuals (165 400 eyes) without schizophrenia (mean age, 65.9 years [13.7]; 53 253 [52.8%] female) were included after images underwent quality control and potentially confounding conditions were excluded. Individuals with schizophrenia were more likely to have hypertension (407 [83.9%] vs 49 971 [48.0%]) and diabetes (364 [75.1%] vs 28 762 [27.6%]). The schizophrenia group had thinner mGC-IPL (-4.05 μm, 95% CI, -5.40 to -2.69; P = 5.4 × 10-9), which persisted when investigating only patients without diabetes (-3.99 μm; 95% CI, -6.67 to -1.30; P = .004) or just those 55 years and younger (-2.90 μm; 95% CI, -5.55 to -0.24; P = .03). On adjusted analysis, retinal fractal dimension among vascular variables was reduced in individuals with schizophrenia (-0.14 units; 95% CI, -0.22 to -0.05; P = .001), although this was not present when excluding patients with diabetes. Conclusions and Relevance In this study, patients with schizophrenia had measurable differences in neural and vascular integrity of the retina. Differences in retinal vasculature were mostly secondary to the higher prevalence of diabetes and hypertension in patients with schizophrenia. The role of retinal features as adjunct outcomes in patients with schizophrenia warrants further investigation.
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Affiliation(s)
- Siegfried K. Wagner
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Mario Cortina-Borja
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Steven M. Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, New York
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York
- Center for Visual Science, University of Rochester, Rochester, New York
| | - Yukun Zhou
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - David Romero-Bascones
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Biomedical Engineering Department, Faculty of Engineering (MU-ENG), Mondragon Unibertsitatea, Mondragón, Spain
| | - Robbert R. Struyven
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Emanuele Trucco
- VAMPIRE Project, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Muthu R. K. Mookiah
- VAMPIRE Project, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Tom MacGillivray
- VAMPIRE Project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Stephen Hogg
- VAMPIRE Project, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Timing Liu
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Dominic J. Williamson
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Nikolas Pontikos
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Praveen J. Patel
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Konstantinos Balaskas
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Daniel C. Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Kelsey V. Stuart
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Anthony P. Khawaja
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Alastair K. Denniston
- University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
| | - Jugnoo S. Rahi
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- Ulverscroft Vision Research Group, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
| | - Axel Petzold
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Pearse A. Keane
- NIHR Moorfields Biomedical Research Centre, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
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Chen X, Zhang X, Gong Z, Yang Y, Zhang X, Wang Q, Wang Y, Xie R. The link between diabetic retinal and renal microvasculopathy is associated with dyslipidemia and upregulated circulating level of cytokines. Front Public Health 2023; 10:1040319. [PMID: 36733289 PMCID: PMC9886881 DOI: 10.3389/fpubh.2022.1040319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Purpose To investigate the mechanisms underlying the correlations between diabetic retinopathy (DR) and diabetic nephropathy (DKD) and examine whether circulating cytokines and dyslipidemia contribute to both DR and DKD in patients with 2 diabetes mellitus (T2DM). Methods A total of 122 patients with T2DM were enrolled and categorized into the DM group (without no DR and DKD), DR group [non-proliferative DR (NPDR), and proliferative DR (PDR)] with no DKD), DR complicated with DKD groups (DR+DKD group). The biochemical profile, including fasting blood glucose (FBG), glycated hemoglobin (HbA1c), and lipid profile were estimated, and plasma inflammatory and angiogenic cytokines [monocyte chemoattractant protein-1 (MCP-1), interleukin (IL)-6, IL-8, vascular endothelial growth factor (VEGF)-A, C, D, and placental growth factor (PlGF)] were analyzed by protein microarrays. The atherogenic plasma index (API) was defined as low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein-cholesterol (HDL-C); atherogenic index (AI) was calculated as [(total cholesterol (TC) -HDL-C)/HDL-C], and atherogenic index of plasma (AIP) was defined as log (TG/HDL-C). Results By multivariable disordered regression analysis, after controlling for duration of DM and hypertension, LDL-C (p = 0.019) and VEGF-D (p = 0.029) resulted as independent risk factors for DR. Albumin-to-creatinine ratio (uACR) (p = 0.003) was an independent risk factor for DR with DKD. In DR, NPDR, and PDR groups, grades of A1, A2, and A3 of albuminuria increased with the severity of DR. In A1, A2, and A3 grade groups, the severity of DR (DM, NPDR, and PDR) increased with higher albuminuria grades. Kendall's tau-b correlation coefficient analysis revealed that FBG (p = 0.019), circulating level of PlGF (p = 0.002), and VEGF-D (p = 0.008) were significantly positively correlated with the grades of uACR (p < 0.001), and uACR grades were significantly correlated with DR severity (p < 0.001). Conclusions The occurrence and severity of DR are closely correlated with kidney dysfunction. Among the three kidney functional parameters, uACR resulted as the better indicator of DR severity and progression than glomerular filtration (eGFR) and serum creatinine (Scr). Impaired FBG was associated with microalbuminuria, emphasizing that well-controlled FBG is important for both DR and DKD. The link between diabetic retinal and renal microvasculopathy was associated with dyslipidemia and upregulated circulating level of angiogenic cytokines.
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Affiliation(s)
- Xiaosi Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China,Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
| | - Xinyuan Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China,Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China,*Correspondence: Xinyuan Zhang ✉
| | - Zhizhong Gong
- Division of Medical Affairs, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yang Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China,Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
| | - Xiaohong Zhang
- Clinical Laboratory of Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qiyun Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China,Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
| | - Yanhong Wang
- Department of Epidemiology and Biostatistics, School of Basic Medicine, Peking Union Medical College, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China
| | - Rui Xie
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China,Beijing Retinal and Choroidal Vascular Diseases Study Group, Beijing, China
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Wu L, Gong X, Wang W, Zhang L, Zhou J, Ming X, Yuan M, Huang W, Wang L. Association of retinal fractal dimension and vessel tortuosity with impaired renal function among healthy Chinese adults. Front Med (Lausanne) 2022; 9:925756. [PMID: 36117976 PMCID: PMC9479094 DOI: 10.3389/fmed.2022.925756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThis study investigated the association of retinal fractal dimension (FD) and blood vessel tortuosity (BVT) with renal function [assessed by estimated glomerular filtrate rate (eGFR)] in healthy Chinese adults using swept-source optical coherence tomographic angiography (SS-OCTA).Materials and methodsThis cross-sectional study was conducted among ocular treatment–naïve healthy participants from Guangzhou, China. FD and BVT in the superficial capillary plexus and deep capillary plexus were measured by SS-OCTA with a 3 × 3 macula model. eGFR was calculated using the Xiangya equation, and impaired renal function (IRF) was defined as eGFR = 90 mL/min/1.73 m2. Linear regression was performed to evaluate the relationships between SS-OCTA metrics and renal function.ResultsA total of 729 participants with a mean age of 57.6 ± 9.1 years were included in the final analysis. Compared to participants with normal renal function, those with IRF had lower FD both in the superficial capillary plexus (1.658 ± 0.029 vs. 1.666 ± 0.024, p = 0.001) and deep capillary plexus (1.741 ± 0.016 vs. 1.746 ± 0.016, p = 0.0003), while the deep BVT was larger in participants with IRF than those with normal renal function (1.007 ± 0.002 vs. 1.006 ± 0.002, p = 0.028). The superficial FD was linearly and positively associated with eGFR after adjusting for confounders (β = 0.2257; 95% CI 0.0829–0.3685; p = 0.002), while BVT was not associated with eGFR (all p ≥ 0.05).ConclusionThe patients with IRF had lower FD and larger BVT than those with normal renal function. The superficial FD decreased linearly with renal function deterioration. Our study suggests that the retinal microvasculature can represent a useful indicator of subclinical renal microvascular abnormalities and serve as a useful non-invasive assessment to predict and monitor the progression of renal function.
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Affiliation(s)
- Linbin Wu
- The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Xia Gong
- Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, China
| | - Wei Wang
- Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, China
| | - Lei Zhang
- The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Jiachen Zhou
- The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Xi Ming
- The First People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Meng Yuan
- Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, China
| | - Wenyong Huang
- Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Wenyong Huang,
| | - Lanhua Wang
- Zhongshan Ophthalmic Center, Guangdong Provincial Clinical Research Center for Ocular Diseases, State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Sun Yat-sen University, Guangzhou, China
- Lanhua Wang,
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Hanssen H, Streese L, Vilser W. Retinal vessel diameters and function in cardiovascular risk and disease. Prog Retin Eye Res 2022; 91:101095. [PMID: 35760749 DOI: 10.1016/j.preteyeres.2022.101095] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 12/13/2022]
Abstract
In the last two decades evidence has gradually accumulated suggesting that the eye may be a unique window for cardiovascular risk stratification based on the assessment of subclinical damage of retinal microvascular structure and function. This can be facilitated by non-invasive analysis of static retinal vessel diameters and dynamic recording of flicker light-induced and endothelial function-related dilation of both retinal arterioles and venules. Recent new findings have made retinal microvascular biomarkers strong candidates for clinical implementation as reliable risk predictors. Beyond a review of the current evidence and state of research, the article aims to discuss the methodological benefits and pitfalls and to identify research gaps and future directions. Above all, the potential use for screening and treatment monitoring of cardiovascular disease risk are highlighted. The article provides fundamental comprehension of retinal vessel imaging by explaining anatomical and physiological essentials of the retinal microcirculation leading to a detailed description of the methodological approach. This allows for better understanding of the underlying retinal microvascular pathology associated with the prevalence and development of cardiovascular disease. A body of new evidence is presented on the clinical validity and predictive value of retinal vessel diameters and function for incidence cardiovascular disease and outcome. Findings in children indicate the potential for utility in childhood cardiovascular disease prevention, and the efficacy of exercise interventions highlight the treatment sensitivity of retinal microvascular biomarkers. Finally, coming from the availability of normative data, solutions for diagnostic challenges are discussed and conceptual steps towards clinical implementation are put into perspective.
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Affiliation(s)
- Henner Hanssen
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland.
| | - Lukas Streese
- Department of Sport, Exercise and Health, Preventive Sports Medicine and Systems Physiology, Medical Faculty, University of Basel, Switzerland
| | - Walthard Vilser
- Institute of Biomedical Engineering and Informatics, Ilmenau University of Technology, Ilmenau, Germany; Neonatology and Pediatric Intensive Care Unit, Department of Pediatrics, Jena University Hospital, Jena, Germany
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Lin W, Luo Y, Liu F, Li H, Wang Q, Dong Z, Chen X. Status and Trends of the Association Between Diabetic Nephropathy and Diabetic Retinopathy From 2000 to 2021: Bibliometric and Visual Analysis. Front Pharmacol 2022; 13:937759. [PMID: 35795563 PMCID: PMC9251414 DOI: 10.3389/fphar.2022.937759] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/06/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Diabetic nephropathy (DN) and diabetic retinopathy (DR) are microvascular complications of diabetes that share a similar pathogenesis and clinical relevance. The study aimed to visually analyze the research status and development trend of the relationship between DN and DR by means of bibliometrics and knowledge mapping. Methods: Publications were collected from the Science Citation Index-Expanded of the Web of Science Core Collection between 2000 and 2021. CiteSpace, Alluvial Generator, and Microsoft Excel were used to analyze and present the data. Results: A total of 3,348 publications were retrieved and 3,285 were included in the analysis after deduplication. The publications demonstrated an annually increasing trend. The results of the collaborative network analysis showed that the United States, Steno Diabetes Center, and Tien Y. Wong were the most influential country, institution and author, in this field of research, respectively. The analysis of references and keywords showed that the pathogenesis of DN and DR and their relationship with cardiovascular disease are research hotspots. The clinical relevance and drug therapy for DN and DR will become frontiers of future research in this field. Conclusion: This study is the first to visualize the correlation between DN and DR using a bibliometric approach. This study provides a reference of research trends for scholars.
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Affiliation(s)
- Wenwen Lin
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou, China
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing, China
| | - Yayong Luo
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou, China
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing, China
| | - Fang Liu
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou, China
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing, China
| | - Hangtian Li
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou, China
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing, China
| | - Qian Wang
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing, China
| | - Zheyi Dong
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing, China
- *Correspondence: Zheyi Dong, ; Xiangmei Chen,
| | - Xiangmei Chen
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou, China
- National Clinical Research Center for Kidney Diseases, State Key Laboratory of Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, Beijing, China
- *Correspondence: Zheyi Dong, ; Xiangmei Chen,
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Theuerle JD, Al-Fiadh AH, Wong E, Patel SK, Ashraf G, Nguyen T, Wong TY, Ierino FL, Burrell LM, Farouque O. Retinal microvascular function predicts chronic kidney disease in patients with cardiovascular risk factors. Atherosclerosis 2021; 341:63-70. [PMID: 34756728 DOI: 10.1016/j.atherosclerosis.2021.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/27/2021] [Accepted: 10/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Endothelial dysfunction is a precursor to atherosclerosis and is implicated in the coexistence between cardiovascular disease (CVD) and chronic kidney disease (CKD). We examined whether retinal microvascular dysfunction is present in subjects with renal impairment and predictive of long-term CKD progression in patients with CVD. METHODS In a single centre prospective observational study, 253 subjects with coronary artery disease and CVD risk factors underwent dynamic retinal vessel analysis. Retinal microvascular dysfunction was quantified by measuring retinal arteriolar and venular dilatation in response to flicker light stimulation. Serial renal function assessment was performed over a median period of 9.3 years using estimated GFR (eGFR). RESULTS Flicker light-induced retinal arteriolar dilatation (FI-RAD) was attenuated in patients with baseline eGFR <90 mL/min/1.73 m2, compared to those with normal renal function (eGFR ≥90 mL/min/1.73 m2) (1.0 [0.4-2.1]% vs. 2.0 [0.8-3.6]%; p < 0.01). In patients with normal renal function, subjects with the lowest FI-RAD responses exhibited the greatest annual decline in eGFR. In uni- and multivariable analysis, among subjects with normal renal function, a 1% decrease in FI-RAD was associated with an accelerated decline in eGFR of 0.10 (0.01, 0.15; p = 0.03) and 0.07 mL/min/1.73 m2 per year (0.00, 0.14; p = 0.06), respectively. FI-RAD was not predictive of CKD progression in subjects with baseline eGFR <90 mL/min/1.73 m2. CONCLUSIONS Retinal arteriolar endothelial dysfunction is present in patients with CVD who have early-stage CKD, and serves as an indicator of long-term CKD progression in those with normal renal function.
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Affiliation(s)
- James D Theuerle
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Ali H Al-Fiadh
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Edmond Wong
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Sheila K Patel
- Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Gizem Ashraf
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Thanh Nguyen
- The Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore
| | | | - Louise M Burrell
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Australia; Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia.
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Aronov M, Allon R, Stave D, Belkin M, Margalit E, Fabian ID, Rosenzweig B. Retinal Vascular Signs as Screening and Prognostic Factors for Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Current Evidence. J Pers Med 2021; 11:jpm11070665. [PMID: 34357132 PMCID: PMC8307097 DOI: 10.3390/jpm11070665] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The substantial burden of kidney disease fosters interest in new ways of screening for early disease diagnosis, especially by non-invasive imaging. Increasing evidence for an association between retinal microvascular signs and kidney disease prompted us to investigate the relevant current literature on such an association systematically by performing a meta-analysis of our findings. METHODS We scrutinized the current literature by searching PubMed and Embase databases from for clinical studies of the association between retinal microvascular signs and prevalent or incident kidney disease. After excluding cases that did not meet our criteria, we extracted relevant data from 42 published studies (9 prospective, 32 cross-sectional, and 1 retrospective). RESULTS Our investigation yielded significant associations between retinal vascular changes (including retinopathy and retinal vascular diameter) and kidney dysfunction (including chronic kidney disease (CKD), end-stage renal disease (ESRD), albuminuria, and estimated glomerular filtration rate (eGFR) decline). According to our meta-analysis, retinopathy was associated with ESRD (hazard ratio (HR) 2.12 (95% confidence interval CI; 1.39-3.22)) and with CKD prevalence in the general population (odds ratio (OR) 1.31 (95% CI; 1.14-1.50)), and specifically in type 2 diabetic patients (OR 1.68 (95% CI; 1.68-2.16)). CRAE was associated with prevalent CKD (OR 1.41 (95% CI; 1.09-1.82)). CONCLUSIONS Our findings suggest that the retinal microvasculature can provide essential data about concurrent kidney disease status and predict future risk for kidney disease development and progression.
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Affiliation(s)
- Michael Aronov
- SPRING Biomed Vision Ltd. 8, Haneviim St., Haifa 3350109, Israel; (R.A.); (D.S.); (E.M.)
- Correspondence: ; Tel.: +972-77-2009796
| | - Raviv Allon
- SPRING Biomed Vision Ltd. 8, Haneviim St., Haifa 3350109, Israel; (R.A.); (D.S.); (E.M.)
| | - Danielle Stave
- SPRING Biomed Vision Ltd. 8, Haneviim St., Haifa 3350109, Israel; (R.A.); (D.S.); (E.M.)
| | - Michael Belkin
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer 5262000, Israel; (M.B.); (I.D.F.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Eyal Margalit
- SPRING Biomed Vision Ltd. 8, Haneviim St., Haifa 3350109, Israel; (R.A.); (D.S.); (E.M.)
| | - Ido Didi Fabian
- The Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer 5262000, Israel; (M.B.); (I.D.F.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Barak Rosenzweig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Urology, Sheba Medical Center, Tel Hashomer 5262000, Israel;
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9
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Zhao X, Liu Y, Zhang W, Meng L, Lv B, Lv C, Xie G, Chen Y. Relationships Between Retinal Vascular Characteristics and Renal Function in Patients With Type 2 Diabetes Mellitus. Transl Vis Sci Technol 2021; 10:20. [PMID: 34003905 PMCID: PMC7884293 DOI: 10.1167/tvst.10.2.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To develop a deep learning-based method to achieve vessel segmentation and measurement on fundus images, and explore the quantitative relationships between retinal vascular characteristics and the clinical indicators of renal function. Methods We recruited patients with type 2 diabetes mellitus with different stages of diabetic retinopathy (DR), collecting their fundus photographs and results of renal function tests. A deep learning framework for retinal vessel segmentation and measurement was developed. The correlation between the renal function indicators and the severity of DR were explored, then the correlation coefficients between indicators of renal function and retinal vascular characteristics were analyzed. Results We included 418 patients (eyes) with type 2 diabetes mellitus. The albumin to creatinine ratio, blood uric acid, blood creatinine, blood albumin, and estimated glomerular filtration rate were significantly correlated with the progression of DR (P < 0.05); no correlation existed in other metrics (P > 0.05). The fractal dimension was found to significantly correlate with most of the clinical parameters of renal function (P < 0.05). Conclusions The albumin to creatinine ratio, blood uric acid, blood creatinine, blood albumin, and estimated glomerular filtration rate have significant correlation with the progression of moderate to proliferative DR. Through deep learning-based vessel segmentation and measurement, the fractal dimension was found to significantly correlate with most clinical parameters of renal function. Translational Relevance Deep learning-based vessel segmentation and measurement on color fundus photographs could explore the relationships between retinal characteristics and renal function, facilitating earlier detection and intervention of type 2 diabetes mellitus complications.
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Affiliation(s)
- Xinyu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Liu
- Ping An Healthcare Technology, Beijing, China
| | - Wenfei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Lihui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Lv
- Ping An Healthcare Technology, Beijing, China
| | | | - Guotong Xie
- Ping An Healthcare Technology, Beijing, China.,Ping An Health Cloud Company Limited, Shenzhen, China.,Ping An International Smart City Technology Company Limited, Shenzhen, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Key Lab of Ocular Fundus Diseases, Chinese Academy of Medical Sciences, Beijing, China
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10
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Lee J, Choe HR, Park SH, Do Han K, Kim DK, Joo KW, Kim YS, Lee EK, Park UC, Yu HG, Lee H, Kim YC, Oh BL. Impact of kidney transplantation on the risk of retinal vein occlusion in end-stage renal disease. Sci Rep 2021; 11:11583. [PMID: 34078921 PMCID: PMC8172893 DOI: 10.1038/s41598-021-90765-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/13/2021] [Indexed: 02/07/2023] Open
Abstract
It has been known that retinal vein occlusion (RVO) is associated with chronic kidney disease, especially end-stage renal disease (ESRD). However, little is known about the effect of kidney transplantation (KT) on RVO incidence in ESRD patients. This study aimed to compare the incidence of RVO in KT recipients (n = 10,498), matched ESRD patients (n = 10,498), and healthy controls (HCs, n = 10,498), using a long-term population-based cohort. The incidence of RVO was 2.74, 5.68, and 1.02 per 1000 patient-years, for the KT group, the ESRD group, and the HCs group, respectively. Adjusted hazard ratios for RVO development compared to the HCs group, were 1.53 and 3.21, in the KT group and the ESRD group, respectively. In the KT group, multivariable regression analysis indicated that an age over 50, a Charlson Comorbidity Index score over 4, and a history of desensitization therapy were associated with an increased risk of RVO. In summary, KT recipients have a lower risk for development of RVO than ESRD patients treated with dialysis. However, the risk is still higher compared to healthy people who have normal kidney functions.
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Affiliation(s)
- Jangwook Lee
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hye Rim Choe
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sang Hyun Park
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Dong Ki Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Kwon Wook Joo
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yon Su Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Eun Kyoung Lee
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Un Chul Park
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyeong Gon Yu
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hajeong Lee
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yong Chul Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Baek-Lok Oh
- Department of Ophthalmology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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11
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Quinn N, Jenkins A, Ryan C, Januszewski A, Peto T, Brazionis L. Imaging the eye and its relevance to diabetes care. J Diabetes Investig 2021; 12:897-908. [PMID: 33190401 PMCID: PMC8169343 DOI: 10.1111/jdi.13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022] Open
Abstract
Diabetes is a major cause of vision loss globally, yet this devastating complication is largely preventable. Early detection and treatment of diabetic retinopathy necessitates screening. Ocular imaging is widely used clinically, both for the screening and management of diabetic retinopathy. Common eye conditions, such as glaucoma, cataracts and retinal vessel thrombosis, and signs of systemic conditions, such as hypertension, are frequently revealed. As well as imaging by a skilled clinician during an eye examination, non-ophthalmic clinicians, such as general practitioners, endocrinologists, nurses and trained health workers, can also can carry out diabetic eye screening. This process usually comprises local imaging with remote grading, mostly human grading. However, grading incorporating artificial intelligence is emerging. In a clinical research context, retinal vasculature analyses using semi-automated software in many populations have identified associations between retinal vessel geometry, such as vessel caliber, and the risk of diabetic retinopathy and other chronic complications of type 1 and type 2 diabetes. Similarly, evaluation of corneal nerves by corneal confocal microscopy is revealing diabetes-related abnormalities, and associations with and predictive power for other chronic diabetes complications. As yet, the value of retinal vessel geometry and corneal confocal microscopy measures at an individual level is uncertain. In this article, targeting non-ocular clinicians and researchers, we review existent and emerging ocular imaging and grading tools, including artificial intelligence, and their associations between ocular imaging findings and diabetes and its chronic complications.
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Affiliation(s)
- Nicola Quinn
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Center for Public HealthQueen’s University BelfastBelfastUK
| | - Alicia Jenkins
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Center for Public HealthQueen’s University BelfastBelfastUK
| | - Chris Ryan
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
| | - Andrzej Januszewski
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
| | - Tunde Peto
- Center for Public HealthQueen’s University BelfastBelfastUK
| | - Laima Brazionis
- National Health and Medical Research Council Clinical Trials CenterThe University of SydneySydneyNew South WalesAustralia
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
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12
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Liu R, Jian W, Zhao Y, Lu X, Wu Y, Duan J. Retinal oxygen saturation and vessel diameter in patients with chronic kidney disease. Acta Ophthalmol 2021; 99:e352-e359. [PMID: 32529722 DOI: 10.1111/aos.14398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 02/20/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate changes in retinal oximetry and the diameter of retinal vasculature in patients with chronic kidney disease (CKD) and relationships between retinal vasculature and the estimated glomerular filtration rate (eGFR), provide a scientific basis for the early detection and diagnosis of CKD. METHODS Eighty-three patients with CKD and 103 healthy individuals were included after providing informed consent. All participants were examined using a noninvasive technology (Oxymap Inc., Reykjavik, Iceland) for measuring the arterial (SaO2 ) and venous (SvO2 ) oxygen saturation and the arteriovenous difference in oxygen saturation (Sa-vO2 ). The corresponding retinal vessel diameters of these arterioles (D-A) and venules (D-V) were measured. The eGFR of patients with CKD was calculated from the serum creatinine concentration. RESULTS In general, patients with CKD had higher mean SaO2 values than healthy individuals (100.15 ± 4.68% versus 97.14 ± 4.22%; p < 0.001, mean ± SD). The mean SaO2 in the superior temporal, superior nasal and inferior nasal quadrants significantly increased. There was no significant difference measured in the SvO2 when patients with CKD (63.66 ± 5.29%) and healthy individuals (62.70 ± 5.27%) were compared. The mean Sa-vO2 of the CKD group (36.49 ± 4.98%) was increased compared with normal subjects (34.44 ± 4.76%) (p = 0.005). The retinal arteriole diameter was narrower in patients with CKD than in normal individuals (117.53 ± 14.88 μm versus 126.87 ± 14.98 μm; p < 0.001, mean ± SD), and the arteriovenous ratio was smaller than in normal individuals (0.71 ± 0.09 versus 0.77 ± 0.09; p < 0.001, mean ± SD). Pearson's two-tailed correlation showed a significant correlation between the SaO2 and eGFR (R = -0.363, p = 0.001), and narrower retinal arterial calibre was significantly associated with a lower eGFR (R = 0.415, p < 0.001). CONCLUSION Based on our results, there were alterations in retinal oxygen saturation and vascular diameter in patients with CKD. Further studies are needed to determine whether such changes play a role in the development of CKD.
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Affiliation(s)
- Ruibao Liu
- Eye College of Chengdu University of TCM Chengdu Sichuan China
| | - Wenyuan Jian
- Eye College of Chengdu University of TCM Chengdu Sichuan China
| | - Ying Zhao
- Eye College of Chengdu University of TCM Chengdu Sichuan China
| | - Xuejing Lu
- Eye College of Chengdu University of TCM Chengdu Sichuan China
- Ineye Hospital of Chengdu University of TCM Chengdu Sichuan China
| | - Yanxia Wu
- Eye College of Chengdu University of TCM Chengdu Sichuan China
| | - Junguo Duan
- Eye College of Chengdu University of TCM Chengdu Sichuan China
- Ineye Hospital of Chengdu University of TCM Chengdu Sichuan China
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13
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Nusinovici S, Sabanayagam C, Lee KE, Zhang L, Cheung CY, Tai ES, Tan GSW, Cheng CY, Klein BEK, Wong TY. Retinal microvascular signs and risk of diabetic kidney disease in asian and white populations. Sci Rep 2021; 11:4898. [PMID: 33649427 PMCID: PMC7921402 DOI: 10.1038/s41598-021-84464-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/11/2021] [Indexed: 12/19/2022] Open
Abstract
The objective was to examine prospectively the association between retinal microvascular signs and development of diabetic kidney disease (DKD) in Asian and White populations. We analysed two population-based cohorts, composing of 1,221 Asians (SEED) and 703 White (WESDR) adults with diabetes. Retinal microvascular signs at baseline included vascular caliber (arteriolar—CRAE, and venular—CRVE) and diabetic retinopathy (DR). Incident cases of DKD were identified after ~ 6-year. Incident cases were defined based on eGFR in SEED and proteinuria or history of renal dialysis in WESDR. The incidence of DKD were 11.8% in SEED and 14.0% in WESDR. Wider CRAE in SEED (OR = 1.58 [1.02, 2.45]) and wider CRVE (OR = 1.69 [1.02, 2.80)) in WESDR were associated with increased risk of DKD. Presence of DR was associated with an increased risk of DKD in both cohorts (SEED: OR = 1.91 [1.21, 3.01] in SEED, WESDR: OR = 1.99 [1.18, 3.35]). Adding DR and retinal vascular calibers in the model beyond traditional risk factors led to an improvement of predictive performance of DKD risk between 1.1 and 2.4%; and improved classification (NRI 3 between 9%). Microvascular changes in the retina are longitudinally associated with risk of DKD.
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Affiliation(s)
- Simon Nusinovici
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Kristine E Lee
- Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, WI, USA.,Department of Biostatistics and Medical Informatics, University of Wisconsin Medical School, Madison, WI, USA
| | - Liang Zhang
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Carol Y Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - E Shyong Tai
- Department of Medicine, National University Health System, National University of Singapore, Singapore, Singapore
| | - Gavin S W Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Ching Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, WI, USA
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
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14
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Xu X, Gao B, Ding W, Wang Q, Zhang M, Tan T, Sun F, Lei J, Ji Q, Xu F. Retinal image measurements and their association with chronic kidney disease in Chinese patients with type 2 diabetes: the NCD study. Acta Diabetol 2021; 58:363-370. [PMID: 33098472 DOI: 10.1007/s00592-020-01621-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/12/2020] [Indexed: 12/29/2022]
Abstract
AIMS Retinal and renal microcirculations are known to share similar physiological changes during early diabetes because of abnormal glucose metabolism and other processes. The retinal vasculature therefore may serve as potential biomarker for the early identification of those at high risk of chronic kidney disease (CKD) in diabetes. METHODS Data from 1925 patients (aged 49.0 ± 10.3) with type 2 diabetes were analyzed. Various retinal image measurements (RIMs) were collected using a validated fully automated computer program. Multiple logistic regressions were performed to investigate the correlation between RIMs and CKD. RESULTS In logistic regression adjusting for multiple variables, wider venular calibers in the central and middle zones and narrower arteriolar caliber in the central zone were associated with CKD (p < 0.001, p = 0.020, and p < 0.001, respectively). Increased arteriolar tortuosity was associated with CKD (p = 0.035). Multiple image texture measurements were also significantly associated with CKD. CONCLUSIONS Renal dysfunction in type 2 diabetes was associated with various retinal image measurements. These non-invasive image measurements may serve as potential biomarkers for the early identification and monitoring of individuals at high risk of CKD in the course of diabetes.
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Affiliation(s)
- Xiayu Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Bin Gao
- Department of Endocrinology, Tangdu Hospital Air Force Military Medical University, Xi'an, 710038, People's Republic of China
| | - Wenxiang Ding
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Qiong Wang
- Department of Endocrinology and Metabolism, Xijing Hospital, Air Force Military Medical University, Xi'an, 710032, People's Republic of China
| | - Maiye Zhang
- Department of Endocrinology and Metabolism, Xijing Hospital, Air Force Military Medical University, Xi'an, 710032, People's Republic of China
| | - Tao Tan
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Fei Sun
- Department of Endocrinology and Metabolism, Xijing Hospital, Air Force Military Medical University, Xi'an, 710032, People's Republic of China
| | - Jianqin Lei
- Department of Ophthalmology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Qiuhe Ji
- Department of Endocrinology and Metabolism, Xijing Hospital, Air Force Military Medical University, Xi'an, 710032, People's Republic of China.
| | - Feng Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.
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15
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Nassir CMNCM, Ghazali MM, Hashim S, Idris NS, Yuen LS, Hui WJ, Norman HH, Gau CH, Jayabalan N, Na Y, Feng L, Ong LK, Abdul Hamid H, Ahamed HN, Mustapha M. Diets and Cellular-Derived Microparticles: Weighing a Plausible Link With Cerebral Small Vessel Disease. Front Cardiovasc Med 2021; 8:632131. [PMID: 33718454 PMCID: PMC7943466 DOI: 10.3389/fcvm.2021.632131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022] Open
Abstract
Cerebral small vessel disease (CSVD) represents a spectrum of pathological processes of various etiologies affecting the brain microcirculation that can trigger neuroinflammation and the subsequent neurodegenerative cascade. Prevalent with aging, CSVD is a recognized risk factor for stroke, vascular dementia, Alzheimer disease, and Parkinson disease. Despite being the most common neurodegenerative condition with cerebrocardiovascular axis, understanding about it remains poor. Interestingly, modifiable risk factors such as unhealthy diet including high intake of processed food, high-fat foods, and animal by-products are known to influence the non-neural peripheral events, such as in the gastrointestinal tract and cardiovascular stress through cellular inflammation and oxidation. One key outcome from such events, among others, includes the cellular activations that lead to elevated levels of endogenous cellular-derived circulating microparticles (MPs). MPs can be produced from various cellular origins including leukocytes, platelets, endothelial cells, microbiota, and microglia. MPs could act as microthrombogenic procoagulant that served as a plausible culprit for the vulnerable end-artery microcirculation in the brain as the end-organ leading to CSVD manifestations. However, little attention has been paid on the potential role of MPs in the onset and progression of CSVD spectrum. Corroboratively, the formation of MPs is known to be influenced by diet-induced cellular stress. Thus, this review aims to appraise the body of evidence on the dietary-related impacts on circulating MPs from non-neural peripheral origins that could serve as a plausible microthrombosis in CSVD manifestation as a precursor of neurodegeneration. Here, we elaborate on the pathomechanical features of MPs in health and disease states; relevance of dietary patterns on MP release; preclinical studies pertaining to diet-based MPs contribution to disease; MP level as putative surrogates for early disease biomarkers; and lastly, the potential of MPs manipulation with diet-based approach as a novel preventive measure for CSVD in an aging society worldwide.
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Affiliation(s)
| | - Mazira Mohamad Ghazali
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Sabarisah Hashim
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Nur Suhaila Idris
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Lee Si Yuen
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Wong Jia Hui
- Neurobiology of Aging and Disease Laboratory, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Haziq Hazman Norman
- Anatomy Unit, International Medical School (IMS), Management and Science University (MSU), Shah Alam, Malaysia
| | - Chuang Huei Gau
- Department of Psychology and Counselling, Faculty of Arts and Social Science, Universiti Tunku Abdul Rahman (UTAR), Kampar, Malaysia
| | - Nanthini Jayabalan
- Translational Neuroscience Lab, University of Queensland (UQ), Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Yuri Na
- Center for Functional Connectomics, Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, South Korea
| | - Linqing Feng
- Center for Functional Connectomics, Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, South Korea
| | - Lin Kooi Ong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- School of Biomedical Sciences and Pharmacy, Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Centre of Research Excellence Stroke Rehabilitation and Brain Recovery, National Health and Medical Research Council (NHMRC), Heidelberg, VIC, Australia
| | - Hafizah Abdul Hamid
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Haja Nazeer Ahamed
- Crescent School of Pharmacy, B.S. Abdur Rahman Crescent Institute of Science and Technology, Chennai, India
| | - Muzaimi Mustapha
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kubang Kerian, Malaysia
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16
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Farrah TE, Dhillon B, Keane PA, Webb DJ, Dhaun N. The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons. Kidney Int 2020; 98:323-342. [PMID: 32471642 PMCID: PMC7397518 DOI: 10.1016/j.kint.2020.01.039] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/09/2020] [Accepted: 01/13/2020] [Indexed: 12/18/2022]
Abstract
Chronic kidney disease (CKD) is common, with hypertension and diabetes mellitus acting as major risk factors for its development. Cardiovascular disease is the leading cause of death worldwide and the most frequent end point of CKD. There is an urgent need for more precise methods to identify patients at risk of CKD and cardiovascular disease. Alterations in microvascular structure and function contribute to the development of hypertension, diabetes, CKD, and their associated cardiovascular disease. Homology between the eye and the kidney suggests that noninvasive imaging of the retinal vessels can detect these microvascular alterations to improve targeting of at-risk patients. Retinal vessel-derived metrics predict incident hypertension, diabetes, CKD, and cardiovascular disease and add to the current renal and cardiovascular risk stratification tools. The advent of optical coherence tomography (OCT) has transformed retinal imaging by capturing the chorioretinal microcirculation and its dependent tissue with near-histological resolution. In hypertension, diabetes, and CKD, OCT has revealed vessel remodeling and chorioretinal thinning. Clinical and preclinical OCT has linked retinal microvascular pathology to circulating and histological markers of injury in the kidney. The advent of OCT angiography allows contrast-free visualization of intraretinal capillary networks to potentially detect early incipient microvascular disease. Combining OCT's deep imaging with the analytical power of deep learning represents the next frontier in defining what the eye can reveal about the kidney and broader cardiovascular health.
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Affiliation(s)
- Tariq E Farrah
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Baljean Dhillon
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; Princess Alexandra Eye Pavilion, Edinburgh, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, UK
| | - David J Webb
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Neeraj Dhaun
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
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Korolj A, Wu HT, Radisic M. A healthy dose of chaos: Using fractal frameworks for engineering higher-fidelity biomedical systems. Biomaterials 2019; 219:119363. [PMID: 31376747 PMCID: PMC6759375 DOI: 10.1016/j.biomaterials.2019.119363] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 07/09/2019] [Accepted: 07/14/2019] [Indexed: 12/18/2022]
Abstract
Optimal levels of chaos and fractality are distinctly associated with physiological health and function in natural systems. Chaos is a type of nonlinear dynamics that tends to exhibit seemingly random structures, whereas fractality is a measure of the extent of organization underlying such structures. Growing bodies of work are demonstrating both the importance of chaotic dynamics for proper function of natural systems, as well as the suitability of fractal mathematics for characterizing these systems. Here, we review how measures of fractality that quantify the dose of chaos may reflect the state of health across various biological systems, including: brain, skeletal muscle, eyes and vision, lungs, kidneys, tumours, cell regulation, skin and wound repair, bone, vasculature, and the heart. We compare how reports of either too little or too much chaos and fractal complexity can be damaging to normal biological function, and suggest that aiming for the healthy dose of chaos may be an effective strategy for various biomedical applications. We also discuss rising examples of the implementation of fractal theory in designing novel materials, biomedical devices, diagnostics, and clinical therapies. Finally, we explain important mathematical concepts of fractals and chaos, such as fractal dimension, criticality, bifurcation, and iteration, and how they are related to biology. Overall, we promote the effectiveness of fractals in characterizing natural systems, and suggest moving towards using fractal frameworks as a basis for the research and development of better tools for the future of biomedical engineering.
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Affiliation(s)
- Anastasia Korolj
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Canada
| | - Hau-Tieng Wu
- Department of Statistical Science, Duke University, Durham, NC, USA; Department of Mathematics, Duke University, Durham, NC, USA; Mathematics Division, National Center for Theoretical Sciences, Taipei, Taiwan
| | - Milica Radisic
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Canada; Toronto General Research Institute, University Health Network, Toronto, Canada; The Heart and Stroke/Richard Lewar Center of Excellence, Toronto, Canada.
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18
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Abstract
Small vessel disease (SVD) refers to conditions where damage to arterioles and capillaries is predominant, leading to reduced, or interrupted perfusion of the affected organ. Data suggest that when this condition is evident in any organ, it is already systemic in its occurrence and consequences. SVD affects primarily organs that receive significant portions of cardiac output such as the brain, the kidney, and the retina. Thus, SVD is a major etiologic cause in debilitating conditions such as renal failure, blindness, lacunar infarcts, and dementia. The factors that lead to this devastating condition include all the known vascular risk factors when they are not strictly controlled, but lifestyles that include sedentary existence, obesity, and poor sleep patterns are also recognized drivers of SVD. In addition, depression is now recognized as a vascular risk factor. Inflammation is a mediator of SVD, but it is not known which factor(s) predominate in its etiology. This article emphasizes the need for more investigations to define this link further and suggests clinical and societal responses that might reduce the major impacts of this condition on populations.
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Affiliation(s)
- Antoine M Hakim
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Faculty of Medicine, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada.,Division of Neurology, University of Ottawa, Ottawa, ON, Canada
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Nusinovici S, Sabanayagam C, Teo BW, Tan GSW, Wong TY. Vision Impairment in CKD Patients: Epidemiology, Mechanisms, Differential Diagnoses, and Prevention. Am J Kidney Dis 2019; 73:846-857. [PMID: 30929852 DOI: 10.1053/j.ajkd.2018.12.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/31/2018] [Indexed: 11/11/2022]
Abstract
Eyes and kidneys have numerous structural, developmental, physiologic, and pathogenic pathways in common, suggesting that many kidney and eye diseases may be interlinked. Studies suggest that the prevalence of eye diseases and vision impairment are higher among persons with end-stage kidney disease and earlier stages of chronic kidney disease (CKD) than in those without. Ocular morbidity in persons with CKD and end-stage kidney disease may be due to the following risk factors: (1) underlying conditions and risk factors for CKD such as diabetes or hypertension, (2) metabolic disorders associated with CKD, (3) uremia and anemia, and (4) CKD treatment. Among the chief eye diseases, diabetic retinopathy and age-related macular degeneration are most consistently associated with CKD. Further research for eye diseases such as glaucoma and cataract is needed to determine their relationships with CKD. Despite the high prevalence and burden of vision impairment among persons with CKD, eye screening in patients with CKD is not currently recommended as standard practice. This review suggests that patients with CKD should be encouraged to undergo a complete eye examination. Furthermore, physicians should be aware that patients undergoing dialysis may develop acute eye problems such as acute glaucoma, and appropriate referral to ophthalmologists should be considered in those with a history of glaucoma or recent ocular surgery. Interdisciplinary collaboration between nephrologists and ophthalmologists will ensure enhanced and appropriate management of patients with CKD.
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Affiliation(s)
- Simon Nusinovici
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Boon Wee Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore.
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20
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Cheung CY, Tang F, Ng DS, Wong R, Lok J, Sun Z, Tso T, Lam A, Brelén M, Chong KK, Luk AO, Chan JC, Wong TY, Tham CC. The Relationship of Quantitative Retinal Capillary Network to Kidney Function in Type 2 Diabetes. Am J Kidney Dis 2018; 71:916-918. [DOI: 10.1053/j.ajkd.2017.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 12/27/2017] [Indexed: 11/11/2022]
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21
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Wang SB, Mitchell P, Liew G, Wong TY, Phan K, Thiagalingam A, Joachim N, Burlutsky G, Gopinath B. A spectrum of retinal vasculature measures and coronary artery disease. Atherosclerosis 2017; 268:215-224. [PMID: 29050745 DOI: 10.1016/j.atherosclerosis.2017.10.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/07/2017] [Accepted: 10/06/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS We aimed to comprehensively describe a spectrum of retinal vessel measures including fractal dimension (Df) and their associations with indices of coronary artery disease (CAD) extent and severity, as well as hypertension and diabetes. METHODS The Australian Heart Eye Study (AHES) is an observational study that surveyed 1680 participants presenting to a tertiary referral hospital for the evaluation of potential CAD by coronary angiography. A range of newer retinal vessel geometric measures (Df, curvature tortuosity, and branching angle) were quantified from retinal photographs using semi-automated software, the Singapore 'I' Vessel Assessment (SIVA) tool. A combined retinal score was constructed, aiming to assess the joint effect of multiple retinal vessel parameters on CAD, comprising of those variables that were most strongly significant in multivariate analysis - Df, arteriolar curvature tortuosity, and retinal arteriolar calibre. CAD was objectively quantified using a range of measures obtained from coronary angiography. RESULTS A total of 1187 participants had complete data on retinal vessel measurements and coronary vessel evaluation. Retinal vascular Df and curvature tortuosity decreased with increasing age; women had significantly lower Df than men (p<0.003). Straighter retinal vessels were associated with CAD extent and Gensini scores in multivariable analysis (p<0.02). Accounting for media opacity by sub-group analysis in pseudophakic patients, the combined retinal score was associated with stenosis greater than 50% in any coronary artery segment (vessel score) and obstructive coronary stenosis in all three main coronary arteries (segment score) (p = 0.01). Lower Df and narrower arteriolar branching angle were associated with CAD vessel score (p<0.03). In sex-stratified multivariate analyses, straighter arterioles were associated with greater odds of CAD in men, and narrower venular branching angle was associated with CAD in women. CONCLUSIONS A range of retinal vessel measures were associated with CAD extent and severity. A sparser retinal microvascular network (smaller Df) was associated with older age and female gender. After accounting for the impact of media opacity, retinal vessel measures were associated with more diffuse and severe CAD.
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Affiliation(s)
- Sarah B Wang
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Paul Mitchell
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Gerald Liew
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Kevin Phan
- Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Aravinda Thiagalingam
- Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Nichole Joachim
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - George Burlutsky
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Bamini Gopinath
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia.
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Retinal Vascular Imaging Markers and Incident Chronic Kidney Disease: A Prospective Cohort Study. Sci Rep 2017; 7:9374. [PMID: 28839244 PMCID: PMC5570935 DOI: 10.1038/s41598-017-09204-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/21/2017] [Indexed: 11/17/2022] Open
Abstract
Retinal microvascular changes indicating microvascular dysfunction have been shown to be associated with chronic kidney disease (CKD) in cross-sectional studies, but findings were mixed in prospective studies. We aimed to evaluate the relationship between retinal microvascular parameters and incident CKD in an Asian population. We examined 1256 Malay adults aged 40–80 years from the Singapore Malay Eye Study, who attended both the baseline (2004–07) and the follow-up (2011–13) examinations and were free of prevalent CKD. We measured quantitative retinal vascular parameters (arteriolar and venular calibre, tortuosity, fractal dimension and branching angle) using a computer-assisted program (Singapore I Vessel Assessment, SIVA) and retinopathy (qualitative parameter) using the modified Airlie house classification system from baseline retinal photographs. Incident CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 + 25% decrease in eGFR during follow-up. Over a median follow-up period of 6 years, 78 (6.21%) developed CKD (70.5% had diabetes). In multivariable models, smaller retinal arterioles (hazards ratio [95% confidence interval] = 1.34 [1.00–1.78]), larger retinal venules (2.35 [1.12–5.94] and presence of retinopathy (2.54 [1.48–4.36]) were associated with incident CKD. Our findings suggest that retinal microvascular abnormalities may reflect subclinical renal microvascular abnormalities involved in the development of CKD.
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Kanar BG, Kanar HS, Karatay A, Tigen K, Sonmez A. Assessment of left atrium and diastolic dysfunction in patients with hypertensive retinopathy: A real-time three-dimensional echocardiography-based study. Clin Exp Hypertens 2017; 39:696-704. [PMID: 28758803 DOI: 10.1080/10641963.2017.1306543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The fundoscopic examination of hypertensive patients, which is established hypertension-related target organ damage (TOD), tends to be underutilized in clinical practice. We sought to investigate the relationship between retinal alterations and left atrium (LA) volumes by means of real-time three-dimensional echocardiography (RT3DE). Our population consisted of 88 consecutive essential hypertensive patients (age 59.2 ± 1.2 years, 35 males). All subjects underwent a fundoscopy examination and were distributed into four groups according to the Keith-Wagener-Barker (KWB) classification. The four groups (KWB grades 0-3: including 26, 20, 26, and 16 patients, respectively) did not differ with regard to age, gender, or metabolic profile. There were no significant differences between groups with regard to parameters reflecting LV systolic function and diastolic dysfunction (DD) in two-dimensional echocardiography (2DE). Nevertheless, patients in the higher KWB category had higher values of LA volumes (LA maximal volume index, LA minimal volume index, preatrial contraction volume index, LA total stroke volume index, LA active stroke volume index, p < 0.001) regarding RT3DE. There is also a significant relationship between LA active stroke volume index (ASVI) and duration of hypertension (HT) (r: 0.68, p < 0.001). In the logistic regression analysis, ASVI was independent predictors of LV DD in patients with arterial hypertension (HT). Patients with arterial HT were found to have increased LA volumes and impaired diastolic functions. Assessment of the arterial HT patient by using RT3DE atrial volume analysis may facilitate early recognition of TOD, which is such a crucial determinant of cardiovascular mortality and morbidity.
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Affiliation(s)
- Batur Gonenc Kanar
- a Saglik Bakanligi Istanbul Sureyyapasa Gogus Hastaliklari ve Gogus Cerrahisi EA Hastanesi , Cardiology , Istanbul , Turkey
| | - Hatice Selen Kanar
- b Fatih Sultan Mehmet Egitim ve Arastirma Hastanesi , Ophthalmology , Istanbul , Turkey
| | - Aysu Karatay
- c Lufti Kirdar Kartal Egitim ve Arastirma Hastanesi , Ophthalmology , Istanbul , Turkey
| | - Kursat Tigen
- d Marmara University Faculty of Medicine , Cardiology , Istanbul , Turkey
| | - Ayse Sonmez
- e Fatih Sultan Mehmet Egitim ve Arastirma Hastanesi , Ophthalmology , Istanbul , Turkey
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Omotoso AB, Kolo PM, Olanrewaju TO, Owoeye JF, Biliaminu SA, Olatunji VA. Relationship between retinopathy and renal abnormalities in black hypertensive patients. Clin Hypertens 2016; 22:19. [PMID: 28828178 PMCID: PMC5562057 DOI: 10.1186/s40885-016-0053-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 10/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Complications of hypertension are particularly common in people of African descent but previous reports had suggested rarity of hypertensive retinopathy in black Africans. We evaluated retinal changes among Nigerian hypertensive patients and determined their relationship with renal function. METHODS Consecutive Hypertensive patients who were ≥18 years were selected for the study. Socio-demographic characteristics, anthropometric parameters and blood pressure were measured. All patients had ophthalmoscopic examination and retinal changes were graded according to Keith-Wegener's classification. Blood samples were taken for blood urea nitrogen, lipids and C-reactive protein; and urine was collected for creatinine and microalbuminuria. Serum creatinine was determined using modified Jaffe method and estimated glomerular filtration (eGFR) was calculated using MDRD equation: 186 × (Creatinine/88.4)-1.154 × (Age)-0.203 × (0.742 if female) × (1.210 if black). RESULTS Of the 240 patients studied, 187 (78 %) had one form of retinopathy or the other. While 85 (35.4 %) patients had grade 1 retinopathy, 87 (36.3 %) had grade 2, 13 (5.4 %) had grade 3 and 2 (0.83 %) had grade 4 respectively. Comparison of patients with and without retinopathy showed that, the former were older (p = 0.001) and had longer duration of hypertension (p = 0.001). Similarly, hypertensive patients with retinopathy had higher total cholesterol and low density lipoprotein cholesterol (p = 0.017, p = 0.041 respectively). However, eGFR was lower in individuals with retinopathy (46.2 ml/min/1.73) than those with normal retinal (55.9 ml/min/1.73) findings, p = 0.019. Multi-variable adjusted odds ratios showed increased probability of retinopathy with age (odds ratio-1.08, p = 0.001) and body mass index (odds ratio-1.20, p = 0.013). CONCLUSIONS Hypertensive retinopathy is a common clinical finding among hypertensive Nigerians and may occur pari passu with renal damage as consequences of long standing hypertension.
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Affiliation(s)
- A B Omotoso
- Department of Medicine, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria
| | - P M Kolo
- Department of Medicine, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria
| | - T O Olanrewaju
- Department of Medicine, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria
| | - J F Owoeye
- Department of Ophthalmology, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria
| | - S A Biliaminu
- Department of Chemical Pathology, University of Ilorin, P.M.B. 1515, Ilorin, Nigeria
| | - V A Olatunji
- Department of Ophthalmology, University of Ilorin Teaching Hospital, P.M.B. 1459, Ilorin, Nigeria
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Lee SR, Choi EK, Rhee TM, Lee HJ, Lim WH, Kang SH, Han KD, Cha MJ, Cho Y, Oh IY, Oh S. Evaluation of the association between diabetic retinopathy and the incidence of atrial fibrillation: A nationwide population-based study. Int J Cardiol 2016; 223:953-957. [PMID: 27589043 DOI: 10.1016/j.ijcard.2016.08.296] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 08/19/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is prevalent among type 2 diabetic patients. However, the association between diabetic retinopathy (DR) and AF is controversial. METHODS We included 40,500 patients with type 2 diabetes (≥40years, mean age 62±11years, 53% men) without AF from the Korean National Insurance Service-National Sample Cohort (2002-2007). Subjects were classified without DR (non-DR, n=30,178), with DR (DR, n=8920), and with proliferative DR (PDR, n=1402). RESULTS During a mean 5.9-year follow-up, 1261 (3.1%) patients were newly diagnosed as having AF (4.9, 6.0, and 8.3 per 1000 person-years in the non-DR, DR, and PDR groups, respectively). In multivariate Cox proportional hazard models, patients in the DR and PDR groups had a significantly higher risk of AF than those in the non-DR group (DR group: hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.00-1.30; PDR group: HR 1.46, 95% CI 1.13-1.87); p for trend <0.001). The risk of AF increased in patients with DR and end-stage renal disease (ESRD) (HR 2.39, 95% CI 1.31-3.96, p<0.001) and in those with PDR and ESRD (HR 3.59, 95% CI 1.96-5.97, p<0.001) compared to those without DR and ESRD. CONCLUSIONS The presence and severity of DR was significantly associated with the incidence of AF. Also, the presence of ESRD had an impact on the incidence of AF in patients with DR.
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Affiliation(s)
- So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Tae-Min Rhee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo-Hyun Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Si-Hyuck Kang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Youngjin Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Il-Young Oh
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Heitmar R, Varma C, De P, Lau YC, Blann AD. The relationship of systemic markers of renal function and vascular function with retinal blood vessel responses. Graefes Arch Clin Exp Ophthalmol 2016; 254:2257-2265. [PMID: 27436082 PMCID: PMC5080305 DOI: 10.1007/s00417-016-3432-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/09/2016] [Accepted: 06/27/2016] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To test the hypothesis of a significant relationship between systemic markers of renal and vascular function (processes linked to cardiovascular disease and its development) and retinal microvascular function in diabetes and/or cardiovascular disease. METHODS Ocular microcirculatory function was measured in 116 patients with diabetes and/or cardiovascular disease using static and continuous retinal vessel responses to three cycles of flickering light. Endothelial function was evaluated by von Willebrand factor (vWf), endothelial microparticles and soluble E selectin, renal function by serum creatinine, creatinine clearance and estimated glomerular filtration rate (eGFR). HbA1c was used as a control index. RESULTS Central retinal vein equivalence and venous maximum dilation to flicker were linked to HbA1c (both p < 0.05). Arterial reaction time was linked to serum creatinine (p = 0.036) and eGFR (p = 0.039); venous reaction time was linked to creatinine clearance (p = 0.018). Creatinine clearance and eGFR were linked to arterial maximum dilatation (p < 0.001 and p = 0.003, respectively) and the dilatation amplitude (p = 0.038 and p = 0.048, respectively) responses in the third flicker cycle. Of venous responses to the first flicker cycle, HbA1c was linked to the maximum dilation response (p = 0.004) and dilatation amplitude (p = 0.017), vWf was linked to the maximum constriction response (p = 0.016), and creatinine clearance to the baseline diameter fluctuation (p = 0.029). In the second flicker cycle, dilatation amplitude was linked to serum creatinine (p = 0.022). CONCLUSIONS Several retinal blood vessel responses to flickering light are linked to glycaemia and renal function, but only one index is linked to endothelial function. Renal function must be considered when interpreting retinal vessel responses.
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Affiliation(s)
- R Heitmar
- Aston University, School of Life and Health Sciences, Aston Triangle, B4 7ET, Birmingham, UK
| | - C Varma
- Department of Cardiology, City Hospital, Birmingham, B18 7QH, UK
| | - P De
- Department of Diabetes and Endocrinology, City Hospital, Birmingham, B18 7QH, UK
| | - Y C Lau
- University of Birmingham Institute for Cardiovascular Sciences, City Hospital, Birmingham, B18 7QH, UK
| | - A D Blann
- University of Birmingham Institute for Cardiovascular Sciences, City Hospital, Birmingham, B18 7QH, UK.
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Joint Effect of Early Microvascular Damage in the Eye &Kidney on Risk of Cardiovascular Events. Sci Rep 2016; 6:27442. [PMID: 27273133 PMCID: PMC4897605 DOI: 10.1038/srep27442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/11/2016] [Indexed: 01/17/2023] Open
Abstract
Microalbuminuria is associated with an increased risk of cardiovascular disease (CVD), but not all individuals require treatment. Retinal microvascular abnormalities and microalbuminuria reflect early systemic microvascular changes. We examined the joint effect of retinal abnormalities and microalbuminuria on CVD risk in an Asian cohort. We conducted a prospective, population-based study. Retinal abnormalities were defined as presence of retinopathy and/or retinal venular widening. Microalbuminuria was defined as urinary albumin: creatinine ratio between 30–300 mg/g. Incident CVD was defined as newly diagnosed clinical stroke, acute myocardial infarction or CVD death. Cox regression models were performed to determine the associations between retinal abnormalities and microalbuminuria with risk of CVD, while controlling for established risk factors. 3,496 participants (aged ≥ 40) were free of prevalent CVD. During the follow-up (5.8 years), 126 (3.60%) participants developed CVD. Persons presenting with both retinal abnormalities and microalbuminuria were 6.71 times (95% CI, 2.68, 16.79) as likely to have incident CVD compared with those without either abnormalities. There was a significant interaction effect between retinal abnormalities and microalbuminuria on incident CVD. Assessment of retinal abnormalities in patients with microalbuminuria may provide additional value in identifying persons at risk of developing CVD.
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