Optical Coherence Tomography and Optical Coherence Tomography–Angiography Chronic Changes in End-Stage Renal Disease: A Systematic Review

<b>Background/Objectives</b>: End-stage renal disease (ESRD) is characterized by profound and progressive microvascular dysfunction that contributes significantly to systemic morbidity. Because the retinal and renal microcirculations share structural and physiological similarities, optical coherence tomography (OCT) and OCT angiography (OCTA) have emerged as promising tools for detecting ocular microvascular changes that may parallel systemic vascular injury. This systematic review aimed to consolidate evidence on chronic retinal and choroidal alterations in ESRD as assessed by OCT and OCTA. <b>Methods</b>: A systematic search of PubMed/MEDLINE (inception-June 2025) was performed using combinations of terms related to OCT, OCTA, ESRD, and hemodialysis. After removing duplicates and screening titles, abstracts, and full texts, we included clinical studies involving adults with ESRD or undergoing dialysis that reported chronic or baseline OCT/OCTA findings. Non-English publications, editorials, conference abstracts, case reports, and studies limited to acute pre-/post-dialysis changes were excluded. Seventeen studies met eligibility criteria. Acute findings were summarized narratively only when no chronic data existed for a specific parameter but were not incorporated into the primary synthesis. <b>Results</b>: Across eligible studies, chronic structural and perfusion abnormalities were consistently reported, including thinning of the retinal nerve fiber and ganglion cell layers, reduced macular and peripapillary vascular densities, enlarged foveal avascular zones, and decreased choroidal thickness. These alterations aligned with markers of disease severity and systemic microvascular burden. <b>Conclusions</b>: Retinal imaging reveals reproducible chronic microvascular changes in ESRD and may serve as an accessible adjunct for systemic vascular assessment. We highlight the potential significance of retinal vascular screening in this population and the need for more standardized imaging protocols to support the effective integration of retinal biomarkers into CKD diagnostic and monitoring strategies.