Correlation between microcirculation characteristics of the macular deep capillary plexus and diabetic kidney disease in patients with type 2 diabetes mellitus_Chinese Journal of Ocular Fundus Diseases

Authors：

Liu Jiajia ^1,2 , Wang Zhina ^1,2 , Ji Zhenning ^1,2 , Feng Shuxian ³ , Zhang Zekun ³ , Li Chenxi ³ , Zheng Dongping ^2,4 , Zhou Guohong ^2,4 ,  Dai Yining ^2,4

1. Medical College, Shanxi Medical University, Taiyuan 030001, China;
2. Shanxi Eye Hospital, Taiyuan 030002, China;
3. School of Precision Instrument and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China;
4. Eye Hospital Affiliated to Shanxi Medical University, Taiyuan 030002, China;

Corresponding?author：

Dai Yining, Email: dyn2013@139.com

Keywords：

Type 2 diabetes; Diabetic retinopathy; Diabetic nephropathies; Optical coherence tomography angiography

DOI：

10.3760/cma.j.cn511434-20250815-00355

Video：

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Objective To investigate the characteristics of microcirculation parameter changes in the deep capillary plexus (DCP) of the macular region in patients with type 2 diabetes mellitus (T2DM) and to analyze their correlation with diabetic kidney disease (DKD). Methods This cross-sectional study included 133 eyes of 133 T2DM patients who visited Shanxi Eye Hospital from March 2022 to May 2024. According to the presence of DKD, the patients were divided into a DKD group (49 eyes of 49 patients) and a non-DKD group (84 eyes of 84 patients). All eyes underwent swept-source optical coherence tomography angiography examination, and 6 mm × 6 mm macular images were acquired. Microcirculation parameters of the superficial capillary plexus (SCP) and DCP were quantitatively analyzed, including vessel diameter (VD), vessel area density (VAD), vessel skeleton density (VSD), and non-perfusion area (NPA). The area of the foveal avascular zone (FAZ) was also measured. Intergroup comparisons were performed using the independent samples t-test or Mann-Whitney U test. Multivariate logistic regression was employed to analyze the independent association between microcirculation parameters of SCP and DCP and DKD after adjusting for diabetic retinopathy (DR) status. Results Compared with the non-DKD group, the DKD group showed significantly increased VD (Z=?3.885) and NPA (Z=?4.268), and significantly decreased VAD (t=2.883) and VSD (t=3.866) in the DCP layer (P＜0.05). No statistically significant differences were observed between the two groups in VD, VAD, VSD, NPA of the SCP layer, or the FAZ area (P＞0.05). After adjusting for DR, multivariate logistic regression analysis indicated that VD [odds ratio (OR)=2.513, 95% confidence interval (CI) 1.445-4.370] and NPA (OR=2.079, 95%CI 1.375-3.143) of the DCP were independent risk factors for DKD in T2DM patients (P＜0.05), whereas VAD (OR=0.810, 95%CI 0.696-0.943) and VSD (OR=0.433, 95%CI 0.271-0.691) of the DCP were protective factors (P＜0.05). Conclusions In T2DM patients, those with DKD exhibit characteristic microcirculatory alterations in the macular DCP, specifically increased VD and NPA, along with decreased VAD and VSD. These abnormalities in DCP microcirculation parameters are independently associated with the occurrence of DKD, suggesting their potential as imaging biomarkers for assessing renal complications in T2DM.

Citation： Liu Jiajia, Wang Zhina, Ji Zhenning, Feng Shuxian, Zhang Zekun, Li Chenxi, Zheng Dongping, Zhou Guohong, Dai Yining. Correlation between microcirculation characteristics of the macular deep capillary plexus and diabetic kidney disease in patients with type 2 diabetes mellitus. Chinese Journal of Ocular Fundus Diseases, 2026, 42(1): 42-48. doi: 10.3760/cma.j.cn511434-20250815-00355 Copy

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6.	劉亞魯, 馮瑞芳, 劉海洋, 等. 2型糖尿病患者黃斑區微血管參數與尿白蛋白/尿肌酐比值的相關性研究[J]. 中華眼底病雜志, 2022, 38(4): 297-303. DOI: 10.3760/cma.j.cn511434-20210518-00256.Liu YL, Feng RF, Liu HY, et al. Correlations between macular microvascular parameters in patients with type 2 diabetes mellitus and urinary albumin creatinine ratio[J]. Chin J Ocul Fundus Dis, 2022, 38(4): 297-303. DOI: 10.3760/cma.j.cn511434-20210518-00256.
7.	Zhao Y, Zhou C, Li F, et al. The retinal blood flow density is related to the pathological severity of diabetic kidney disease[J]. Ophthalmic Res, 2024, 67(1): 558-566. DOI: 10.1159/000541354.
8.	中華醫學會糖尿病學分會. 中國糖尿病防治指南(2024版)[J]. 中華糖尿病雜志, 2025, 17(1): 16-139. DOI: 10.3760/cma.j.cn115791-20241203-00705.Chinese Diabetes Society. Guideline for the prevention and treatment of diabetes mellitus in China (2024 edition)[J]. Chin J Diabetes Mellitus, 2025, 17(1): 16-139. DOI: 10.3760/cma.j.cn115791-20241203-00705.
9.	KDOQI. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease[J]. Am J Kidney Dis, 2007, 49(2, Supplement 2): S12-S154. DOI:10.1053/j.ajkd.2006.12.005.
10.	Tuttle KR, Bakris GL, Bilous RW, et al. Diabetic kidney disease: a report from an ADA Consensus Conference[J]. Diabetes Care, 2014, 37(10): 2864-2883. DOI: 10.2337/dc14-1296.
11.	Scilletta S, Di Marco M, Miano N, et al. Update on diabetic kidney disease (DKD): focus on non-albuminuric DKD and cardiovascular risk[J/OL]. Biomolecules, 2023, 13(5): 752[2023-04-26]. https://doi.org/10.3390/biom13050752. DOI:10.3390/biom13050752.
12.	Butt A, Mustafa N, Fawwad A, et al. Relationship between diabetic retinopathy and diabetic nephropathy; a longitudinal follow-up study from a tertiary care unit of karachi, pakistan[J]. Diabetes Metab Syndr, 2020, 14(6): 1659-1663. DOI: 10.1016/j.dsx.2020.08.026.
13.	Xue C, Chen K, Gao Z, et al. Common mechanisms underlying diabetic vascular complications: focus on the interaction of metabolic disorders, immuno-inflammation, and endothelial dysfunction[J/OL]. Cell Commun Signal, 2023, 21(1): 298[2023-10-30]. https://doi.org/10.1186/s12964-022-01016-w. DOI:10.1186/s12964-022-01016-w.
14.	Carnevali A, Sacconi R, Corbelli E, et al. Optical coherence tomography angiography analysis of retinal vascular plexuses and choriocapillaris in patients with type 1 diabetes without diabetic retinopathy[J]. Acta Diabetol, 2017, 54(7): 695-702. DOI: 10.1007/s00592-017-0996-8.
15.	Scarinci F, Picconi F, Giorno P, et al. Deep capillary plexus impairment in patients with type 1 diabetes mellitus with no signs of diabetic retinopathy revealed using optical coherence tomography angiography[J/OL]. Acta Ophthalmol, 2018, 96(2): e264-e265[2017-09-09]. https://doi.org/10.1111/aos.13510. DOI:10.1111/aos.13510.
16.	Dimitrova G, Chihara E, Takahashi H, et al. Quantitative retinal optical coherence tomography angiography in patients with diabetes without diabetic retinopathy[J]. Invest Ophthalmol Vis Sci, 2017, 58(1): 190-196. DOI: 10.1167/iovs.16-20531.
17.	Yao H, Li Z. Is preclinical diabetic retinopathy in diabetic nephropathy individuals more severe?[J/OL]. Front Endocrinol, 2023, 14: 1144257[2023-03-17]. https://doi.org/10.3389/fendo.2023.1144257. DOI:10.3389/fendo.2023.1144257.
18.	張佳慧, 陳曉隆. 2型糖尿病患者黃斑區結構改變與視力的相關性分析[J]. 中華眼底病雜志, 2020, 36(5): 370-373. DOI: 10.3760/cma.j.cn511434-20190305-00069.Zhang JH, Chen XL. Correlation between the changes of macular structure and visual acuity in patients with type 2 diabetes mellitus[J]. Chin J Ocul Fundus Dis, 2020, 36(5): 370-373. DOI: 10.3760/cma.j.cn511434-20190305-00069.

1. Mao W, Yip CMW, Chen W. Complications of diabetes in China: health system and economic implications[J/OL]. BMC Public Health, 2019, 19(1): 269[2019-03-06]. https://doi.org/10.1186/s12889-019-6569-8. DOI:10.1186/s12889-019-6569-8.
2. 中華醫學會內分泌學分會. 中國成人糖尿病腎臟病臨床診斷的專家共識[J]. 中華內分泌代謝雜志, 2015, 31(5): 379-385. DOI: 10.3760/cma.j.issn.1000-6699.2015.05.001.Chinese Society of Endocrinology. Expert consensus on clinical diagnosis of adult diabetic kidney disease in China[J]. Chin J of Endocrinol Metab, 2015, 31(5): 379-385. DOI: 10.3760/cma.j.issn.1000-6699.2015.05.001.
3. Lin YC, Chang YH, Yang SY, et al. Update of pathophysiology and management of diabetic kidney disease[J]. J Formos Med Assoc, 2018, 117(8): 662-675. DOI: 10.1016/j.jfma.2018.02.007.
4. Laíns I, Wang JC, Cui Y, et al. Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA)[J/OL]. Pro Retin Eye Res, 2021, 84: 100951[2021-01-28]. https://doi.org/10.1016/j.preteyeres.2021.100951. DOI: 10.1016/j.preteyeres.2021.100951.
5. da Silva MO, do Carmo Chaves AEC, Gobbato GC, et al. Early choroidal and retinal changes detected by swept-source oct in type 2 diabetes and their association with diabetic kidney disease: a longitudinal prospective study[J/OL]. BMC Ophthalmol, 2024, 24: 85[2024-02-23]. https://doi.org/10.1186/s12886-024-03346-4. DOI:10.1186/s12886-024-03346-4.
6. 劉亞魯, 馮瑞芳, 劉海洋, 等. 2型糖尿病患者黃斑區微血管參數與尿白蛋白/尿肌酐比值的相關性研究[J]. 中華眼底病雜志, 2022, 38(4): 297-303. DOI: 10.3760/cma.j.cn511434-20210518-00256.Liu YL, Feng RF, Liu HY, et al. Correlations between macular microvascular parameters in patients with type 2 diabetes mellitus and urinary albumin creatinine ratio[J]. Chin J Ocul Fundus Dis, 2022, 38(4): 297-303. DOI: 10.3760/cma.j.cn511434-20210518-00256.
7. Zhao Y, Zhou C, Li F, et al. The retinal blood flow density is related to the pathological severity of diabetic kidney disease[J]. Ophthalmic Res, 2024, 67(1): 558-566. DOI: 10.1159/000541354.
8. 中華醫學會糖尿病學分會. 中國糖尿病防治指南(2024版)[J]. 中華糖尿病雜志, 2025, 17(1): 16-139. DOI: 10.3760/cma.j.cn115791-20241203-00705.Chinese Diabetes Society. Guideline for the prevention and treatment of diabetes mellitus in China (2024 edition)[J]. Chin J Diabetes Mellitus, 2025, 17(1): 16-139. DOI: 10.3760/cma.j.cn115791-20241203-00705.
9. KDOQI. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease[J]. Am J Kidney Dis, 2007, 49(2, Supplement 2): S12-S154. DOI:10.1053/j.ajkd.2006.12.005.
10. Tuttle KR, Bakris GL, Bilous RW, et al. Diabetic kidney disease: a report from an ADA Consensus Conference[J]. Diabetes Care, 2014, 37(10): 2864-2883. DOI: 10.2337/dc14-1296.
11. Scilletta S, Di Marco M, Miano N, et al. Update on diabetic kidney disease (DKD): focus on non-albuminuric DKD and cardiovascular risk[J/OL]. Biomolecules, 2023, 13(5): 752[2023-04-26]. https://doi.org/10.3390/biom13050752. DOI:10.3390/biom13050752.
12. Butt A, Mustafa N, Fawwad A, et al. Relationship between diabetic retinopathy and diabetic nephropathy; a longitudinal follow-up study from a tertiary care unit of karachi, pakistan[J]. Diabetes Metab Syndr, 2020, 14(6): 1659-1663. DOI: 10.1016/j.dsx.2020.08.026.
13. Xue C, Chen K, Gao Z, et al. Common mechanisms underlying diabetic vascular complications: focus on the interaction of metabolic disorders, immuno-inflammation, and endothelial dysfunction[J/OL]. Cell Commun Signal, 2023, 21(1): 298[2023-10-30]. https://doi.org/10.1186/s12964-022-01016-w. DOI:10.1186/s12964-022-01016-w.
14. Carnevali A, Sacconi R, Corbelli E, et al. Optical coherence tomography angiography analysis of retinal vascular plexuses and choriocapillaris in patients with type 1 diabetes without diabetic retinopathy[J]. Acta Diabetol, 2017, 54(7): 695-702. DOI: 10.1007/s00592-017-0996-8.
15. Scarinci F, Picconi F, Giorno P, et al. Deep capillary plexus impairment in patients with type 1 diabetes mellitus with no signs of diabetic retinopathy revealed using optical coherence tomography angiography[J/OL]. Acta Ophthalmol, 2018, 96(2): e264-e265[2017-09-09]. https://doi.org/10.1111/aos.13510. DOI:10.1111/aos.13510.
16. Dimitrova G, Chihara E, Takahashi H, et al. Quantitative retinal optical coherence tomography angiography in patients with diabetes without diabetic retinopathy[J]. Invest Ophthalmol Vis Sci, 2017, 58(1): 190-196. DOI: 10.1167/iovs.16-20531.
17. Yao H, Li Z. Is preclinical diabetic retinopathy in diabetic nephropathy individuals more severe?[J/OL]. Front Endocrinol, 2023, 14: 1144257[2023-03-17]. https://doi.org/10.3389/fendo.2023.1144257. DOI:10.3389/fendo.2023.1144257.
18. 張佳慧, 陳曉隆. 2型糖尿病患者黃斑區結構改變與視力的相關性分析[J]. 中華眼底病雜志, 2020, 36(5): 370-373. DOI: 10.3760/cma.j.cn511434-20190305-00069.Zhang JH, Chen XL. Correlation between the changes of macular structure and visual acuity in patients with type 2 diabetes mellitus[J]. Chin J Ocul Fundus Dis, 2020, 36(5): 370-373. DOI: 10.3760/cma.j.cn511434-20190305-00069.

Chinese Journal of Ocular Fundus Diseases

Correlation between microcirculation characteristics of the macular deep capillary plexus and diabetic kidney disease in patients with type 2 diabetes mellitus

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