Accelerated Peripapillary Retinal Nerve Fiber Layer Degeneration in Patients With Chronic Kidney Disease: A 2-Year Longitudinal Study

Purpose: To evaluate the longitudinal changes in the peripapillary retinal nerve fibelayer (pRNFL) in patients with chronic kidney disease (CKD). Methods: In this prospective cohort study, the CKD group consisted of patients with CKD stage ≥ 3. Age-matched healthy controls were enrolled at a 1:4 ratio. Spectral-domain optical coherence tomography was used to measure the pRNFL at baseline, 1 year, and 2 years. Within-group longitudinal changes and between-group comparisons were performed using linear mixed models. Results: Overall, 152 patients with CKD and 40 controls were included (mean ages, 62.8 ± 9.1 years vs. 63.0 ± 9.3 years; P = 0.931). The CKD group showed faster loss of pRNFL than the control group (−0.87 μm/y vs. −0.26 μm/y; P = 0.004). Subgroup analysis found that the rate of pRNFL change was −0.41 μm/y in stage 3a CKD, −0.74 μm/y in stage 3b, −0.98 μm/y in stage 4/5, and −1.38 μm/y in end-stage renal disease. Multiple linear regression analysis revealed that CKD stage (coefficient =−0.549; 95% confidence inter-val [CI], −0.966 to −0.131; P = 0.010), hypertension (coefficient =−1.557; 95% CI −3.013 to −0.101; P = 0.036), and rim area (coefficient = −1.505; 95% CI, −2.940 to −0.070; P = 0.040) were factors associated with the pRNFL change over 2 years. Conclusions: Patients with CKD experienced faster pRNFL loss than healthy controls did. Severity of CKD, hypertension, and rim area were independent factors associated with the loss of pRNFL. Translational Relevance: This study contributes to our understanding of retinal neurodegeneration in normal aging and in patients with chronic kidney diseases.