Diabetic retinopathy is a prognostic factor for progression of chronic kidney disease in the patients with type 2 diabetes mellitus

Abstract

Since both retinopathy and nephropathy are major diabetic microvascular complications, we investigated whether severity of diabetic retinopathy (DR) has adverse effects on renal function and albuminuria in the patients with type 2 diabetes mellitus (DM). We screened 2,197 adult patients with type 2 DM who had undergone fundus exam between August 2006 and February 2014. Among them, 1,592 subjects with available serial renal function and albuminuria measurement were included in the analysis. DR status was classified as no DR, non-proliferative DR (NPDR), and proliferative DR (PDR). The risk of CKD progression was assessed according to DR severity. A total of 384 (24.1%) had NPDR and 202 (12.7%) had PDR at either eye. The mean follow-up period was 5.6±2.1 years. DR was associated with lower body mass index, lower plasma hemoglobin, lower serum albumin level, longer duration of DM, poorer control of blood sugar, lower estimated glomerular filtration rate (eGFR), and greater amount of albuminuria. Interestingly, baseline DR severity was associated with faster renal function decline and greater albuminuria progression. In multivariate analysis, NPDR had 2.9 times and PDR had 16.6 times higher risk for CKD progression. Our findings showed that baseline DR severity is a prognostic factor for future CKD progression in type 2 DM patients. Therefore, clinicians must evaluate DR severity at the first visit and closely monitor renal function and albuminuria in the subjects with severe DR.

Metabolomics profiles associated with diabetic retinopathy in type 2 diabetes patients

“…Renal dysfunction is associated with DR development and deterioration [ 27 ]. Additionally, it has been reported that DR is a prognostic factor of progression of chronic kidney disease in T2D patients [ 9 ]. These results could suggest that serum creatinine is also a candidate marker of DR development in diabetic patients.…”

Relationship Between Retinal Capillary Nonperfusion Area and Renal Function in Patients With Type 2 Diabetes

“…The association between DR and diabetic nephropathy, two important microvascular complications of DM, has been actively investigated, and the results have implied an intimate relationship between the manifestations and severity of DR and renal function and its progression in patients with DM. 5,6,8,9,[22][23][24][25][26] Retinal capillary nonperfusion is a major sign of microvascular insufficiency of DR, reflecting the extent of ischemia and is directly involved in development of PDR, the end stage of DR. 14,16,18,27 Ultra-widefield imaging has enabled more thorough assessments of retinal vascularity including the far peripheral retina, therefore enabling a more precise assessment of the NPA in DR eyes. [14][15][16]18,28 In this study, we measured retinal NPAs quantitatively on UWFA in an objective manner and analyzed their correlation with renal function in patients with type 2 DM with DR.…”

Association of diabetic nephropathy with diabetic retinopathy in type 2 diabetes mellitus patients

“…Studies have speculated that similar pathogenesis or molecular pathways lead to the development of diabetic renal and retinal microvascular injury. 4,22 They have suggested that the higher association rates of DN and DR may be because the patients who have already developed DR are more vulnerable to develop DN. It has also been suggested that the preexistence of one microvascular complication (DR or DN) may contribute to the development of another one.…”