Association between macular vessel density and microvascular biomarkers in pediatric chronic kidney disease

Purpose This study evaluated retinal microvasculature changes in children with chronic kidney disease (CKD) using optical coherence tomography angiography (OCTA). It aimed to identify associations between OCTA parameters and serum levels of vitamin D, asymmetric dimethyl arginine (ADMA), vascular endothelial growth factor-A (VEGF-A), and angiopoietin-2 (Ang-2), and to examine their relationship with CKD progression as measured by estimated glomerular filtration rate (eGFR). Patients and methods A single-center, cross-sectional, prospective correlation study used OCTA to compare retinal vessel density (VD) and foveal avascular zone area in 105 children: 35 on dialysis, 35 with nondialysis CKD, and 35 controls. Blood tests assessed kidney function and microvascular markers including ADMA, VEGF-A, and Ang-2. Results Compared with controls, both CKD groups showed significantly lower VD in the macula. Additionally, both CKD groups had a larger foveal avascular zone area. In the dialysis group, vitamin D levels positively correlated with VD, while ADMA and Ang-2 levels negatively correlated. In the nondialysis group, albumin and vitamin D levels positively correlated with VD, while ADMA, VEGF, and Ang-2 levels were negatively correlated. Conclusion Our findings suggest that OCTA is a valuable tool for monitoring microvascular health in children with CKD and highlights the potential roles of vitamin D, ADMA, Ang-2, and VEGF in CKD progression and microvascular damage. Keywords: angiopoietins, Asymmetric dimethylarginine, optical coherence tomography angiography, pediatric chronic kidney disease, retinal microvascular, vascular endothelial growth factor-A