Long-term follow-up study of 268 diabetic patients undergoing haemodialysis, with special attention to visual acuity and heterogeneity

Watanabe, Yoshio; Yuzawa, Yukio; Mizumoto, D.; Tamai, Hiroaki; Itoh, Yasuhiko; Kumon, Saeko; Yamazaki, Chikao

doi:10.1093/ndt/8.8.725

Cited by 27 publications

(17 citation statements)

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“…It has been observed that after renal transplantation or initiation of dialysis, visual function stabilizes (28). The stabilization could also be due to other factors, such as lower blood pressure during renal replacement therapy (29). A strong positive association between the severity of retinopathy and the severity of nephropathy was noted in this study (r ϭ 0.63, P Ͻ 0.001), which supports the hypothesis that there are common predisposing factors behind these two microvascular complications.…”

Section: Discussionsupporting

confidence: 84%

Heritability of Proliferative Diabetic Retinopathy

Hietala

Forsblom²,

Summanen³

et al. 2008

Diabetes

154

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on behalf of the FinnDiane Study Group OBJECTIVE-Diabetic nephropathy clusters in families, suggesting that genetic factors play a role in its pathogenesis. We investigated whether similar clustering exists for proliferative retinopathy in families with two or more siblings with type 1 diabetes. RESEARCH DESIGN AND METHODS-TheFinnDiane Study has characterized 20% (4,800 patients) of adults with type 1 diabetes in Finland. In 188 families, there were at least two siblings with type 1 diabetes. Ophthalmic records were obtained for 369 of 396 (93%) and fundus photographs for 251 of 369 (68%) patients. Retinopathy was graded based on photographs and/or repeated ophthalmic examinations using the Early Treatment of Diabetic Retinopathy grading scale.RESULTS-Mean age at onset of diabetes was 14.3 Ϯ 10.2 years, and mean duration was 25.9 Ϯ 11.8 years. Proliferative retinopathy was found in 115 of 369 patients (31%). The familial risk of proliferative retinopathy was estimated in 168 of 188 sibships, adjusted for A1C, duration, and mean blood pressure. Proliferative retinopathy in the probands (48 of 168) was associated with an increased risk (odds ratio 2.76 [95% CI 1.25-6.11], P ϭ 0.01) of proliferative retinopathy in the siblings of probands (61 of 182). The heritability of proliferative retinopathy was h 2 ϭ 0.52 Ϯ 0.31 (P Ͻ 0.05). After 20 years of diabetes, almost all patients with type 1 diabetes and 58% of patients with type 2 diabetes show signs of retinopathy. When retinopathy worsens, severe visual loss eventually threatens 5-10% of patients (2). The most severe form of retinopathy is proliferative retinopathy, and most of the patients with this complication will become blind after 5-10 years without treatment (3). The prevalence of proliferative retinopathy varies between 13 and 50% after 15-20 years of diabetes duration in patients needing insulin (2,4). CONCLUSIONS-WeThe prevalence of any retinopathy is strongly related to duration and glucose exposure (2,4). Furthermore, poor glycemic control increases the incidence and progression of retinopathy (5,6). Nevertheless, glycemic exposure seems to explain only a part of the risk of proliferative retinopathy (7). In patients with type 2 diabetes, high blood pressure increases the incidence of retinopathy (8). It is noteworthy that proliferative retinopathy is associated with diabetic nephropathy, a complication that is at least in part genetically determined (2). Such an association suggests that familial factors may also contribute to the development of proliferative retinopathy.Therefore, the aim of this study was to elucidate whether there is a familial clustering of proliferative retinopathy in patients with longstanding type 1 diabetes and to estimate the degree of familiality by calculating the heritability of proliferative retinopathy. RESEARCH DESIGN AND METHODSThe present study was undertaken as part of the ongoing FinnDiane Study (Finnish Diabetic Nephropathy Study), a nationwide multicenter project with the aim of identifying genetic and environmenta...

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Section: Discussionsupporting

confidence: 84%

Heritability of Proliferative Diabetic Retinopathy

Hietala

Forsblom²,

Summanen³

et al. 2008

Diabetes

154

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“…In several studies, the effect of HD on diabetic retinopathy with or without macular edema was evaluated by fluorescein angiography or ophthalmoscopy [2,3,12,13,14,15,16]. All these studies refer to the effect of HD only on the leakage of diabetic macular edema, as angiography cannot detect retinal thickness changes.…”

Section: Discussionmentioning

confidence: 99%

Hemodialysis-Induced Alterations in Macular Thickness Measured by Optical Coherence Tomography in Diabetic Patients with End-Stage Renal Disease

Theodossiadis¹,

Theodoropoulou

Neamonitou³

et al. 2011

Ophthalmologica

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Background/Aims: To evaluate changes in macular thickness measured by optical coherence tomography (OCT) during a hemodialysis (HD) session in diabetic patients with end-stage renal disease. Methods: 72 eyes of 36 diabetic patients with and without macular edema were evaluated before and immediately after an HD session. Average and maximum macular thicknesses in the central disk (6 mm in diameter) and total macular volume were measured. Results: In the eyes with diabetic macular edema, maximum macular thickness within the central disk of 6 mm, and mainly in its peripheral parts, was significantly reduced by 31.18 ± 4.18 µm after HD (p < 0.001). Average macular thickness and total macular volume were also significantly reduced (p = 0.003 and 0.015, respectively). In diabetic eyes without edema, maximum macular thickness decreased significantly by 11.21 ± 1.98 µm after HD (p < 0.001), while average macular thickness and total macular volume decreased slightly (p = 0.034, p = 0.043). Best-corrected visual acuity failed to change. We found a significant association of macular thickness changes with osmolality reduction and the presence of macular edema. Conclusion: HD decreases macular thickness in diabetic patients with macular edema, while there exists a less-pronounced effect in diabetic eyes without edema.

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“…In one study, 73.1% of eyes already had visual disturbance and 11% were blind at the time of dialysis initiation 31. Historically, HD has been associated with the stabilisation of retinopathy (87.1% of eye visual acuity stable over at least 2 years follow-up) 31.…”

Section: What Effect Does Diabetes Have On Mortality and Morbidity Inmentioning

confidence: 99%

Managing diabetes in dialysis patients

O'Toole¹,

Fan²,

Yaqoob³

et al. 2012

Postgraduate Medical Journal

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Burgeoning levels of diabetes are a major concern for dialysis services, as diabetes is now the most common cause of end-stage renal disease in most developed nations. With the rapid rise in diabetes prevalence in developing countries, the burden of end stage renal failure due to diabetes is also expected to rise in such countries. Diabetic patients on dialysis have a high burden of morbidity and mortality, particularly from cardiovascular disease, and a higher societal and economic cost compared to non-diabetic subjects on dialysis. Tight glycaemic and blood pressure control in diabetic patients has an important impact in reducing risk of progression to end stage renal disease. The evidence for improving glycaemic control in patients on dialysis having an impact on mortality or morbidity is sparse. Indeed, many factors make improving glycaemic control in patients on dialysis very challenging, including therapeutic difficulties with hypoglycaemic agents, monitoring difficulties, dialysis strategies that exacerbate hyperglycaemia or hypoglycaemia, and possibly a degree of therapeutic nihilism or inertia on the part of clinical diabetologists and nephrologists. Standard drug therapy for hyperglycaemia (eg, metformin) is clearly not possible in patients on dialysis. Thus, sulphonylureas and insulin have been the mainstay of treatment. Newer therapies for hyperglycaemia, such as gliptins and glucagon-like peptide-1 analogues have become available, but until recently, renal failure has precluded their use. Newer gliptins, however, are now licensed for use in 'severe renal failure', although they have yet to be trialled in dialysis patients. Diabetic patients on dialysis have special needs, as they have a much greater burden of complications (cardiac, retinal and foot). They may be best managed in a multidisciplinary diabetic-renal clinic setting, using the skills of diabetologists, nephrologists, clinical nurse specialists in nephrology and diabetes, along with dietitians and podiatrists.

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Long-term follow-up study of 268 diabetic patients undergoing haemodialysis, with special attention to visual acuity and heterogeneity

Cited by 27 publications

References 0 publications

Heritability of Proliferative Diabetic Retinopathy

Heritability of Proliferative Diabetic Retinopathy

Hemodialysis-Induced Alterations in Macular Thickness Measured by Optical Coherence Tomography in Diabetic Patients with End-Stage Renal Disease

Managing diabetes in dialysis patients

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