Diabetic Retinopathy as a Risk Factor for Chronic Kidney Disease Progression: A Multicenter Case–Control Study in Taiwan

Abstract

It has rarely been studied whether the presence and severity of diabetic retinopathy (DR) could influence the renal disease progression among all chronic kidney disease (CKD) diabetic patients. This study investigates the characteristics of diabetic patients, with different stages of chronic kidney disease (CKD), according to the occurrence of diabetic retinopathy and determines the influence of retinopathy in the deterioration of renal function. We conduct a multicenter, longitudinal cohort study based on the Epidemiology and Risk Factors Surveillance of the CKD project (2008–2013) and the National Health Insurance Research Database (NHIRD) (2001–2013). A total of 4050 diabetic patients with CKD, 20–85 years of age, from 14 hospitals and the community are included in this study. As compared to CKD patients without DR, CKD patients with DR have a lower baseline estimated glomerular filtration rate (eGFR) (39.17 ± 30.36 mL/min per 1.73 m2 vs. 54.38 ± 33.67 mL/min per 1.73 m2 ); poorer glycemic control (higher glycated hemoglobin (HbA1c) 7.85 ± 4.97 vs. 7.29 ± 4.02, p < 0.01); higher proteinuria (urine protein-to-creatinine ratio (UPCR )1.94 ± 2.96 g/dL vs. 0.91 ± 2.11 g/dL, p < 0.01); more anemia (Hb 11.22 ± 2.43 g/dL vs. 12.39 ± 3.85 g/dL, p < 0.01), and more hypoalbuminemia (3.88 ± 0.95 g/dL vs. 4.16 ± 1.74 g/dL, p < 0.01). Later stage (stage 3b–5) CKD patients with DR had significantly higher CKD progression compared with patients without DR (OR (odds ratio) 1.66 (1.36–2.02)). Patients with proliferative DR had significantly higher CKD progression events compared to patients with non-proliferative DR (OR 2.18 (1.71–2.78)). The presence and severity of DR is a risk factor for CKD progression among our Taiwanese CKD patients with diabetes. Prevention and early detection of DR are important and DR should be routinely screened as early as possible among diabetic CKD patients.

The Severity of Diabetic Retinopathy Is an Independent Factor for the Progression of Diabetic Nephropathy

“…There were significant differences in DR severity, age, uric acid, albumin and more hypertension events than in other studies [8,23,24]. Patients with DR had a worse baseline eGFR, worse glycemic control (higher HbA1c) and higher uric acid.…”

“…Our study cohort included all CKD stages. A previous study found that DR is significantly correlated with CKD progression in later CKD stages [8]. This may be because the association between DR severity and ESRD events was weaker than for the baseline CKD stage.…”

“…A Korean populationbased retrospective study showed that NPDR has a 2.9 times and PDR has a 16.6 times higher risk for CKD progression than the no DR group after adjustment [6]. However, a multicenter case-control study in Taiwan revealed that PDR is significantly associated with CKD progression after adjustments for baseline eGFR, hypertension, HbA1c, and BMI, but NPDR is not [8]. A longitudinal Japanese cohort of patients with type 2 diabetes with biopsy-proven diabetic kidney disease showed the risk for ESRD increased in a stepwise fashion after adjusting from mild NPDR to moderate NPDR, to severe NPDR, to PDR [9].…”

“…However, the association between the severity of DR and renal disease progression among patients with type 2 diabetes has rarely been studied and is unclear. A Taiwan case-control study among patients with type 2 diabetes revealed that PDR is significantly associated with CKD progression but NPDR is not [8]. A Japanese cohort of biopsy-proven diabetic kidney disease among patients with type 2 diabetes showed the risk for end-stage renal disease (ESRD) increased in a stepwise fashion, from mild NPDR to moderate NPDR, to severe NPDR, to PDR [9].…”

Proteinuria as a Potential Biomarker for the Efficacy of Intravitreal Bevacizumab Injection in Patients with Diabetic Macular Edema

“…In contrast, another study reported association of ratio of glycated albumin to HbA1c, an indicator reflecting fluctuations in plasma glucose, with DR but not with DN [34]. Although controversies remain, a relationship between DR and kidney function has been identified [35,36]. Comorbidity of DR and DN is common in diabetic patients; the two entities have a similar pathogenesis, including endothelial dysfunction, thickened basement membrane, and/or chronic inflammation [37].…”