Aims

Patients with chronic kidney disease (CKD) in type 2 diabetes typically manifest with severe peripheral neuropathy. Corneal confocal microscopy is a novel technique that may serve as a marker of nerve injury in peripheral neuropathy. This study examines the changes that occur in corneal nerve morphology as a result of peripheral neuropathy due to renal dysfunction in people with type 2 diabetes.

Methods

Sixty-two participants (mean age, 62 ± 12 years) with type 2 diabetes and 25 age-matched healthy controls underwent a comprehensive assessment of neuropathy using the total neuropathy score (TNS). The corneal sub-basal nerve plexus was imaged using corneal confocal microscopy. Corneal nerve fiber length, fiber density, branch density, total branch density, nerve fractal dimension, inferior whorl length and inferior whorl nerve fractal dimension were quantified. Based on the eGFR, participants were classified into those with diabetic CKD (eGFR < 60; n = 22) and those without CKD (eGFR ≥ 60; n = 40).

Results

Participants with diabetic CKD had significantly lower corneal nerve fiber density (P = 0.037), length (P = 0.036) and nerve fractal dimension (P = 0.036) compared to those without CKD. Multiple linear regression analysis revealed that reduced corneal nerve fiber density (ß coefficient = 0.098, P = 0.017), length (ß coefficient = 0.006, P = 0.008) and nerve fractal dimension (ß coefficient = 0.001, P = 0.007) was associated with low eGFR levels when adjusted for age, duration of diabetes and severity of neuropathy.

Conclusion

Corneal confocal microscopy detects corneal nerve loss in patients with diabetic CKD and reduction in corneal nerve parameters is associated with the decline of kidney function.

中文翻译：

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患有慢性肾脏疾病的糖尿病患者的角膜神经纤维丢失。

目的

2型糖尿病慢性肾脏病（CKD）患者通常表现出严重的周围神经病变。角膜共聚焦显微镜术是一种新技术，可作为周围神经病变中神经损伤的标志。这项研究调查了2型糖尿病患者由于肾功能不全而导致的周围神经病变导致角膜神经形态发生的变化。

方法

使用总神经病评分（TNS）对62位2型糖尿病参与者和25位年龄匹配的健康对照者（平均年龄62±12岁）进行了神经病综合评估。使用角膜共聚焦显微镜对角膜下基底神经丛成像。定量角膜神经纤维长度，纤维密度，分支密度，总分支密度，神经分形维数，下螺纹长度和下螺纹神经分形尺寸。根据eGFR，将参与者分为糖尿病CKD（eGFR <60; n = 22）和无CKD（eGFR≥60; n = 40）。

结果

与没有CKD的参与者相比，患有糖尿病CKD的参与者的角膜神经纤维密度（P  = 0.037），长度（P  = 0.036）和神经分形维数（P  = 0.036）明显降低。多元线性回归分析显示，降低的角膜神经纤维密度（ß系数= 0.098，P  = 0.017），长度（ß系数= 0.006，P  = 0.008）和神经分形维数（ß系数= 0.001，P  = 0.007）与根据年龄，糖尿病持续时间和神经病严重程度进行调整后，eGFR水平较低。

结论

角膜共聚焦显微镜检查可检测出患有糖尿病CKD的患者的角膜神经丢失，而角膜神经参数的减少与肾脏功能的下降有关。