More Impact of Microalbuminuria on Retinopathy Than Moderately Reduced GFR Among Type 2 Diabetic Patients

Abstract

OBJECTIVEThe current study aimed to investigate whether microalbuminuria or moderately decreased glomerular filtration rate (GFR) is a better predictor for the development and progression of retinopathy in type 2 diabetic patients.RESEARCH DESIGN AND METHODSType 2 diabetic patients without cardiovascular diseases, malignancy, pregnancy, and acute intercurrent illness were enrolled between 1 August 2001 and 31 December 2002. All participants provided their detailed medical history and underwent an eye fundus examination. They were followed up in outpatient clinics, and serum creatinine, urinary albumin-to-creatinine ratio (UACR), and retinal photographs were followed up annually until 31 December 2009. The primary outcomes were development and progression of diabetic retinopathy and nephropathy. The secondary outcomes were cardiovascular events and all-cause mortality.RESULTSAmong 487 participants, 81 subjects had normoalbuminuria and moderate renal impairment (baseline eGFR 30–59.9 mL/min/1.73 m2), and 106 subjects had microalbuminuria and baseline eGFR ≥60 mL/min/1.73 m2. Patients with microalbuminuria and eGFR ≥60 mL/min/1.73 m2 had a significantly greater risk for development and progression of diabetic retinopathy (HR 3.34 [95% CI 1.04–10.70]) compared with those with moderate renal impairment and normoalbuminuria after multivariate adjustment. Risks for renal outcome, cardiovascular events, and all-cause mortality were not significantly different between the two groups.CONCLUSIONSMicroalbuminuria has a greater impact on predicting the development and progression of diabetic retinopathy compared with moderate decline in GFR among type 2 diabetic patients.

Plasma Ghrelin Concentrations Are Negatively Correlated With Urine Albumin-to-Creatinine Ratio in Newly Diagnosed Type 2 Diabetes

“…However, many factors such as exercise, hypertension and hyperglycemia can influence daily urinary albumin excretion. 32 Even the UACR values are less than the recommended cutoff value (30 mg/g); we emphasize the importance of regular follow-up of UACR in old subjects with low plasma ghrelin levels. 30,31 No previous study has reported the association between the UACR values and ghrelin/obestatin concentrations.…”

Diabetic Retinopathy and Microalbuminuria Can Predict Macroalbuminuria and Renal Function Decline in Japanese Type 2 Diabetic Patients

“…Therefore, we need to perform ophthalmological examination to detect DR carefully, especially in the patients with normo- or microalbuminuria, to identify persons at higher risk of developing macroalbuminuria. It has not been shown that DR itself is related to renal function decline, although some reports have shown that urinary abnormalities, microalbuminuria, or macroalbuminuria predicts DR (26), and microalbuminuria has been indicated to have a greater impact on predicting DR than GFR decline in type 2 diabetic patients (27). …”

Renal cortex echogenicity increases degree of retinopathy in diabetes mellitus

“…This correlation may be explained by assuming that the appearance of microalbuminuria is a sign of a general vascular dysfunction, including retinal vascular dysfunction. (12,13) In our study, 34 (82.9%) of the patients entering the study had proteinuria of +1, which could explain the positive correlation between the degree of cortex echogenicity and the degree of retinopathy. Albuminuria and associated complications appear to be primarly caused by enzymes with a susceptibility to hyperglycemia, that are involved in the metabolism of anionic components of the extracellular matrix (eg heparan sulfate proteoglycan).…”