Retinal capillary and arteriolar changes in patients with chronic kidney disease
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Updated: Feb 13, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Agnes Bosch1, Johannes B Scheppach1, Joanna M Harazny2
1Department of Nephrology and Hypertension, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Germany.
Insights
Patients with chronic kidney disease (CKD) exhibit retinal signs of end-organ damage, including increased arteriolar wall-to-lumen ratio and capillary rarefaction, indicating premature cardiovascular disease risk.
Area of Science:
- Nephrology
- Ophthalmology
- Cardiovascular Medicine
Background:
- Chronic kidney disease (CKD) is a significant risk factor for premature cardiovascular disease.
- Vascular remodeling and capillary rarefaction are known complications of CKD in animal models, but human data are limited.
- Retinal arteriolar wall-to-lumen ratio (WLR) serves as a marker for early end-organ damage, potentially reflecting cerebrovascular changes.
Purpose of the Study:
- To compare retinal capillary density and arteriolar structure in patients with CKD versus healthy individuals.
- To investigate the presence of vascular remodeling and capillary rarefaction in the retinal microcirculation of CKD patients.
Main Methods:
- Cross-sectional study comparing 76 CKD patients (stage 3+ or proteinuria >500 mg/g creatinine) with 53 healthy controls.
- Non-invasive in vivo measurement of retinal vascular parameters using scanning laser Doppler Flowmetry (SLDF).
- Assessment of capillary rarefaction via intercapillary distance (ICD) and arteriolar structure via wall-to-lumen ratio (WLR) and wall thickness (WT).
Main Results:
- CKD patients demonstrated a significantly higher WLR (0.403 ± 0.11 vs 0.351 ± 0.11, p=0.010) and wall thickness (WT) (15.1 ± 4.1 vs 13.5 ± 3.8, p=0.026) compared to controls.
- Increased intercapillary distance (ICD) (22.4 ± 5.7 vs 20.2 ± 4.1, p=0.008) was observed in CKD patients, indicating capillary rarefaction.
- These differences remained significant after adjusting for clinical characteristics, with a positive correlation found between serum phosphate and WLR in CKD patients (r=0.288, p=0.013).
Conclusions:
- Patients with moderately severe CKD exhibit retinal evidence of end-organ damage.
- Increased WLR and capillary rarefaction in the retina suggest microvascular alterations associated with CKD.
- These retinal findings may serve as indicators of systemic vascular damage and increased cardiovascular risk in CKD patients.
Rationale:
Premature cardiovascular disease is a leading cause of death in patients with chronic kidney disease (CKD). In animal models CKD has been shown to cause renal and extrarenal vascular remodeling and capillary rarefaction, but data in humans with CKD are sparse. Retinal arteriolar wall-to-lumen ratio (WLR) is an established marker of early end-organ damage and there is evidence that arteriolar and capillary changes in the retinal circulation mirror those in the general and in particular the cerebrovascular microcirculation.
Objective:
The aim of this study was to compare retinal capillary density and arteriolar structure between patients with CKD and healthy individuals.
Methods:
We compared 76 patients with CKD stage 3+ or proteinuria >500 mg/g creatinine in the presence of a normal GFR from the German Chronic Kidney Disease cohort to 53 healthy control subjects, who participated in clinical trials during 2007 and 2015 in our Clinical Research Center. Retinal vascular parameters were measured non-invasively in vivo by scanning laser Doppler Flowmetry (SLDF, Heidelberg Engineering, Germany). Capillary rarefaction was assessed by intercapillary distance.
Results:
Patients with CKD showed greater WLR (0.403 ± 0.11 vs 0.351 ± 0.11, p = 0.010) and greater wall thickness (WT) (15.1 ± 4.1 vs 13.5 ± 3.8, p = 0.026) compared to healthy individuals. Intercapillary distance (ICD) (22.4 ± 5.7 vs 20.2 ± 4.1, p = 0.008) was greater in the CKD group compared to the healthy control group. After adjustment for differences in clinical characteristics of the groups (age, gender, BMI, serum cholesterol) WLR (p = 0.046), WT (p = 0.025) and ICD (p = 0.003) remained significantly different between the two groups. There was a correlation between serum phosphate level and WLR in the CKD group (r = 0.288, p = 0.013).
Conclusion:
Patients with moderately severe CKD show retinal signs of end-organ damage indicated by an increased wall-to-lumen ratio and capillary rarefaction.
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