Retinopathy predicts progression of diabetic renal disease

  • Park HC & al.
  • PLoS One
  • 29 Jul 2019

  • International Clinical Digest
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Takeaway

  • Baseline severity of diabetic retinopathy (DR) predicts excess risk for progression of chronic kidney disease (CKD) among patients with type 2 diabetes (T2D).

Why this matters

  • Renal function and albuminuria should be closely monitored in patients with severe retinopathy.

Study design

  • Korean study of 1592 patients with T2D (mean age, 57.9±11.2 years) with baseline fundus exam and serial renal measurements.
  • 24.1% had nonproliferative DR (NPDR) and 12.7% had proliferative DR (PDR).
  • Mean follow-up, 5.6±2.1 years.
  • Funding: None.     

Key results

  • Patients with baseline DR had longer T2D duration and lower BMI, plasma hemoglobin, serum albumin, diabetic control, and estimated glomerular filtration rate (in mL/minute/1.73 m2) than those without (all P<.001>
  • CKD progression was highest with PDR (49.5%) and NPDR (29.9%) vs no-DR (9.5%).
  • Baseline DR severity was tied to greater annual decline in renal function vs no-DR at all CKD stages (NPDR and PDR vs no-DR, all P<.001 style="list-style-type:circle;">
  • Stage I: −3.2±6.44 and −4.16±5.43 vs −0.83±3.48;
  • Stage II: −1.91±5.71 and −3.97±6.08 vs 0.47±3.22;
  • Stage IIIa: −0.53±4.25 and −2.58±5.71 vs 1.24±3.91; and
  • Stage IIIb: −2.3±3.34 and −2.89±9.19 vs 0.5±4.34. 
  • In multivariate analysis with no-DR as comparator, odds of CKD progression were:
    • 2.9-fold with NPDR (P<.001>
    • 16.6-fold with PDR (P=.004).
  • Limitations

    • Retrospective, monocentric design.