CKD: diabetic retinopathy tied to increased risk for progression

  • Lin HT & al.
  • Nutrients
  • 27 Feb 2019

  • International Clinical Digest
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Takeaway

  • Diabetic retinopathy presence and severity are tied to an increased risk for chronic kidney disease (CKD) progression.

Why this matters

  • Findings warrant prevention, early detection, and aggressive management of retinopathy in patients with comorbid diabetes and CKD.

Study design

  • Multicenter longitudinal study of 4050 diabetic patients with CKD aged 20-85 (mean, ~65.5) years, from the Taiwanese Epidemiology and Risk Factors Surveillance of the CKD project and the National Health Insurance Research Database.
  • 1481 (36.6%) had diabetic retinopathy; 518 patients (35.0%) were proliferative.
  • CKD progression defined as estimated glomerular filtration rate (eGFR, in mL/minute/1.73 m2) decrease >5 per year.
  • Funding: Taiwanese Ministry of Health and Welfare.

Key results

  • CKD patients with vs without diabetic retinopathy had:
    • Lower baseline eGFR: 39.17±30.36 vs 54.38±33.67.
    • Higher HbA1c: 7.85%±4.97% vs 7.29%±4.02%.
    • Higher urine protein-to-creatinine ratio (UPCR): 1.94±2.96 vs 0.91±2.11 g/dL.
    • More anemia: hemoglobin, 11.22±2.43 vs 12.39±3.85 g/dL.
    • More hypoalbuminemia: 3.88±0.95 vs 4.16±1.74 g/dL.
    • More CKD progression events: 21.67% vs 13.62% (all P<.01>
  • In multivariate analysis, diabetic retinopathy was tied to 37% higher odds of CKD progression (OR=1.37; P<.05>
  • Risk was exacerbated in a subset of patients with stage IIIb-IV CKD (OR=1.47; P<.05>
  • Risk was higher with proliferative vs nonproliferative retinopathy (OR=1.82; P<.05>

Limitations

  • Incident CKD not captured.