Ischemic diabetic retinopathy as a possible prognostic factor for chronic kidney disease progression

Abstract

Purpose To assess the value of diabetic retinopathy (DR) severity as a possible predictive prognostic factor for the progression of chronic kidney disease (CKD). Patients and methods Retrospective cohort study. Patients (51) who were initially diagnosed with DR and CKD were enrolled and their medical records were evaluated. The following ophthalmic factors were assessed by fluorescein angiography at the initial visit: area of capillary nonperfusion, presence of neovascularization and vitreous hemorrhage, and DR grade. The effect of these factors on CKD progression over the 2-year period of the study, defined as doubling of serum creatinine or the development of end-stage renal disease requiring dialysis or renal transplant, was evaluated. Results The study included 51 patients with DR and CKD; of these, 11 patients (21.6%) were found to have proliferative DR (PDR) and seven patients (13.7%) had highrisk PDR at baseline. Patients with ischemic DR, who showed extensive capillary nonperfusion (Z10 optic disc areas) in the retina, had a greater risk for CKD progression (hazard ratio ¼ 6.64; P ¼ 0.002). Conclusion We found that extensive capillary nonperfusion in the retina greatly increased the risk of progression of CKD in patients with DR. This suggests that the retina and the kidney may have shared risk factors for microvascular disease secondary to diabetes mellitus, and emphasizes the need for a team approach to diabetes care.

Association of Abnormal Renal Profiles and Proliferative Diabetic Retinopathy and Diabetic Macular Edema in an Asian Population With Type 2 Diabetes

“…13 On the other hand, one study demonstrated that a more extensive nonperfusion area in the retina increased the risk of progression of CKD over a 2-year period. 14 These studies strengthened the link between diabetic retinopathy and nephropathy, suggesting that either one may progress along with the other. Chronic kidney disease has been implicated in the production of vascular endothelial growth factors (VEGF) that are normally detected in podocytes in glomeruli and tubular epithelial cells.…”

The Relationship Between Diabetic Retinopathy and Diabetic Nephropathy in a Population-Based Study in Korea (KNHANES V-2, 3)

“…Few studies have demonstrated that CKD is associated with DR and it is not clear if CKD in the absence of albuminuria is associated with DR. [47][48][49] Sabanayagam et al 47 demonstrated that CKD is associated with DR only in the presence of albuminuria, suggesting that CKD is more likely related to diabetes in the presence of albuminuria. Lee et al 48 demonstrated that ischemic DR characterized with extensive capillary nonperfusion is a possible prognostic factor for the progression of CKD. Additional studies are needed to explore the relationship between DR and CKD further.…”

Chronic Kidney Disease and Diabetic Retinopathy in Patients with Type 2 Diabetes

“…Recently, Lee et al [ 31 ] showed a direct association between DR and CKD. The presence of CKD identified a group of DM2 patients of being at a greater risk of presenting macro and microvascular complications.…”