Objective To investigate the association between chronic kidney disease (CKD) severity and macular retinal structural differences measured by spectral-domain optical coherence tomography (SD-OCT), and to determine whether layer- and sector-specific retinal thinning patterns reflect systemic microvascular involvement. Methods In this cross-sectional study of 1,515 participants with CKD from the UK Biobank, individuals were classified as CKD stages 1–2 or stages 3–5 according to KDIGO guidelines. Macular thickness was assessed across Early Treatment of Diabetic Retinopathy Study (ETDRS) sectors and segmented retinal layers. Eye-level linear mixed-effects models with a random intercept for participant ID were used to examine associations between CKD stage and retinal thickness, adjusting for age, sex, body mass index, systolic blood pressure, diastolic blood pressure, hemoglobin A1c (HbA1c), and intraocular pressure. A false discovery rate (FDR) correction was applied for multiple comparisons. Results Compared with CKD stages 1–2, CKD stage 3–5 was independently associated with significant thinning of multiple inner and photoreceptor-related retinal layers, including INL–ELM (<InlineEquation ID="IEq1"><EquationSource Format="TEX">\(\beta = -1.52\,\mu\)</EquationSource></InlineEquation>m), INL–RPE (<InlineEquation ID="IEq2"><EquationSource Format="TEX">\(\beta = -2.57\,\mu\)</EquationSource></InlineEquation>m), IS OS-RPE (<InlineEquation ID="IEq3"><EquationSource Format="TEX">\(\beta = -1.02\,\mu\)</EquationSource></InlineEquation>m), and GCIPL (<InlineEquation ID="IEq4"><EquationSource Format="TEX">\(\beta = -1.05\,\mu\)</EquationSource></InlineEquation>m) (all FDR-adjusted <InlineEquation ID="IEq5"><EquationSource Format="TEX">\(p < 0.05\)</EquationSource></InlineEquation>). Outer macular thickness was also significantly reduced. Sectoral analysis demonstrated pronounced thinning across all parafoveal sectors and most perifoveal sectors. In contrast, ELM-IS OS thickness, macular RNFL, and central macular thickness were not significantly associated with CKD stage after multiple-comparison correction. Thinning patterns were spatially consistent across macular regions. Conclusion CKD stage 3–5 is associated with subtle but consistent macular retinal thinning, predominantly affecting parafoveal regions and inner retinal and photoreceptor-related layers. These findings support the potential role of OCT-derived macular metrics as noninvasive indicators of systemic microvascular burden in CKD.

Optical coherence tomographic retinal differences across stages of chronic kidney disease

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2026年8月4日

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Samit Kumar Ghosh,
Rizwan Malik,
Ahsan Habib Khandoker

摘要

Objective

To investigate the association between chronic kidney disease (CKD) severity and macular retinal structural differences measured by spectral-domain optical coherence tomography (SD-OCT), and to determine whether layer- and sector-specific retinal thinning patterns reflect systemic microvascular involvement.

Methods

In this cross-sectional study of 1,515 participants with CKD from the UK Biobank, individuals were classified as CKD stages 1–2 or stages 3–5 according to KDIGO guidelines. Macular thickness was assessed across Early Treatment of Diabetic Retinopathy Study (ETDRS) sectors and segmented retinal layers. Eye-level linear mixed-effects models with a random intercept for participant ID were used to examine associations between CKD stage and retinal thickness, adjusting for age, sex, body mass index, systolic blood pressure, diastolic blood pressure, hemoglobin A1c (HbA1c), and intraocular pressure. A false discovery rate (FDR) correction was applied for multiple comparisons.

Results

Compared with CKD stages 1–2, CKD stage 3–5 was independently associated with significant thinning of multiple inner and photoreceptor-related retinal layers, including INL–ELM (\(\beta = -1.52\,\mu\)m), INL–RPE (\(\beta = -2.57\,\mu\)m), IS OS-RPE (\(\beta = -1.02\,\mu\)m), and GCIPL (\(\beta = -1.05\,\mu\)m) (all FDR-adjusted \(p < 0.05\)). Outer macular thickness was also significantly reduced. Sectoral analysis demonstrated pronounced thinning across all parafoveal sectors and most perifoveal sectors. In contrast, ELM-IS OS thickness, macular RNFL, and central macular thickness were not significantly associated with CKD stage after multiple-comparison correction. Thinning patterns were spatially consistent across macular regions.

Conclusion

CKD stage 3–5 is associated with subtle but consistent macular retinal thinning, predominantly affecting parafoveal regions and inner retinal and photoreceptor-related layers. These findings support the potential role of OCT-derived macular metrics as noninvasive indicators of systemic microvascular burden in CKD.