Diabetic Retinopathy in Patients with Diabetic Nephropathy: Development and Progression

Abstract

The purpose of current study aims to investigate the development and progression of diabetic retinopathy (DR) in patients with diabetic nephropathy (DN) in a nationwide population-based cohort in Taiwan. Newly diagnosed DN patients and age- and sex-matched controls were identified from the Taiwanese Longitudinal Health Insurance Database from 2000 to 2010. We studied the effects of age, sex, hypertension, dyslipidemia, diabetic polyneuropathy (DPN), and medications on the development of nonproliferative DR (NPDR), proliferative DR (PDR), and diabetic macular edema (DME) in patients with DN. Cox proportional hazard regression analyses were used to estimate the adjusted hazard ratios (HRs) of the development of DR. Our results show that the adjusted HRs of NPDR and PDR were 5.01 (95% confidence interval (CI) = 4.68–5.37) and 9.7 (95% CI = 8.15–11.5), respectively, in patients with DN as compared with patients in the non-DN cohort. At 5-year follow-up, patients with DN showed an increased HR of NPDR progression to PDR (HR = 2.26, 95% CI = 1.68–3.03), and the major comorbidities were hypertension (HR = 1.23, 95% CI = 1.10–1.38 with NPDR; HR = 1.33, 95% CI = 1.02–1.72 with PDR) and DPN (HR = 2.03, 95% CI = 1.72–2.41 in NPDR; HR = 2.95, 95% CI = 2.16–4.03 in PDR). Dyslipidemia increased the HR of developing NPDR but not PDR or DME. Moreover, DN did not significantly affect DME development (HR = 1.47, 95% CI = 0.87–2.48) or progression (HR = 0.37, 95% CI = 0.11–1.20). We concluded that DN was an independent risk factor for DR development and progression; however, DN did not markedly affect DME development in this study, and the potential association between these disorders requires further investigation.

Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review

“…The presence of microalbuminuria was found to independently increase the risk of DR, severe DR and DMO, and the risk further increased in the presence of macroalbuminuria . However, research has also shown that nephropathy did not affect development or progression of DMO, although it was an independent risk factor for DR, PDR and the progression from non‐proliferative DR (NPDR) to PDR . Previously, macroalbuminuria, but not microalbuminuria, had been found to be significantly associated with increasing severity of DR and with progression from NPDR to PDR in T2DM …”

“…Although a previous study demonstrated that these two complications influence the incidence of each other, a retrospective study in T2DM demonstrated that the association between DR and diabetic nephropathy is unidirectional and that renal injury precedes retinal damage . Accordingly, several studies have shown that nephropathy is a risk factor for DR, including severe forms of retinopathy . Concerning T1DM, a 20‐year prospective study by Romero‐Aroca et al found that both micro‐ and macroalbuminuria correlated with the development of VTDR but not with the development of any DR .…”

“…30 However, research has also shown that nephropathy did not affect development or progression of DMO, although it was an independent risk factor for DR, PDR and the progression from non-proliferative DR (NPDR) to PDR. 31 Previously, macroalbuminuria, but not microalbuminuria, had been found to be significantly associated with increasing severity of DR and with progression from NPDR to PDR in T2DM. 32 Diabetic symmetric polyneuropathy is also a major risk factor for foot ulcers and amputations.…”

“…37 Accordingly, several studies have shown that nephropathy is a risk factor for DR, including severe forms of retinopathy. 28,[30][31][32] Concerning T1DM, a 20-year prospective study by Romero-Aroca et al found that both micro-and macroalbuminuria correlated with the development of VTDR but not with the development of any DR. 28 In the same study, DR was a significant risk factor for nephropathy. 28 Notably, in a 10-year prospective analysis of patients with T1DM, macroalbuminuria was identified as a significant independent risk factor for the development of DMO, but not of DR. 29 Concerning T2DM, Hammes et al analysed data from 6478 patients.…”

Cubilin Single Nucleotide Polymorphism Variants are Associated with Macroangiopathy While a Matrix Metalloproteinase-9 Single Nucleotide Polymorphism Flip-Flop may Indicate Susceptibility of Diabetic Nephropathy in Type-2 Diabetic Patients

“…1). We found that GG-homozygosity was significantly associated with DN in univariate modeling (p = 0.011) and in a multivariate model (OR 6.07 [1.60-22.99], p = 0.008) of clinical factors previously attributed to DN [14,15] (Table 2). Additionally, advanced stages of CKD were independently associated with DN (OR 1.93 [1.15-3.23], p = 0.012).…”