Overt Proteinuria, Moderately Reduced eGFR and Their Combination Are Predictive of Severe Diabetic Retinopathy or Diabetic Macular Edema in Diabetes

Abstract

Citation: Yamamoto M, Fujihara K, Ishizawa M, et al. Overt proteinuria, moderately reduced eGFR and their combination are predictive of severe diabetic retinopathy or diabetic macular edema in diabetes. Invest Ophthalmol Vis Sci. 2019;60:2685-2689. https://doi.org/10.1167 PURPOSE. Since the combined effects of proteinuria and a moderately decreased eGFR on incident severe eye complications in patients with diabetes are still largely unknown, these associations were determined in a large historical cohort of Japanese patients with diabetes mellitus. METHODS.We evaluated the effects of overt proteinuria (OP) (dipstick 1þ and over) and/or moderately reduced estimated glomerular filtration rate (eGFR) (MG) (baseline eGFR 30.0-54.9 mL/min/1.73 m 2 ) on the incidence of treatment-required diabetic eye diseases (TRDED). We divided 7709 patients into four groups according to the presence or absence of OP and MG: no OP without MG (NP[MGÀ]), OP without MG (OP[MGÀ]), no OP with MG (NP[MGþ]), and OP with MG (OP[MGþ]). Multivariate Cox analyses were performed to calculate hazard ratios (HRs) with 95% confidence intervals for combinations of the presence and/or absence of OP and MG on the risk of developing TRDED. RESULTS.During the median follow-up period of 5.6 years, 168 patients developed TRDED. HRs for OP and MG for incident TRDED were 1.91 (95% confidence interval, 1.27-2.87) and 1.90 (1.11-3.23), respectively. HRs for incident TRDED were 1.73 (1.11-2.69) and 5.57 (2.40-12.94) for OP(MGÀ) and OP(MGþ), respectively, in comparison with NP(MGÀ). CONCLUSIONS.In Japanese patients with diabetes, OP and MG were separately as well as additionally associated with higher risks of TRDED. Results indicate the necessity of the simultaneous assessment of proteinuria and eGFR for appropriate evaluation of risks of severe eye complications in patients with diabetes.

Renal Biomarkers for Treatment Effect of Ranibizumab for Diabetic Macular Edema

“…In this study, we found that the severity of proteinuria was correlated with baseline CFT and the presence of intraretinal cysts at baseline. The association between albuminuria and DME had been reported in the previous studies [ 7 – 9 , 12 ]. Both microalbuminuria and macroalbuminuria were recognized as risk factors for the development of DME, with the latter exerting a greater impact [ 6 , 8 ].…”

Differences in Risk Factors for Diabetic Retinopathy in Type 1 and Type 2 Diabetes Mellitus Patients in North-East Poland

“…In turn, the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) confirmed that in diabetes lasting for 10 years proliferative diabetic retinopathy (PDR) was three times more frequent in patients with proteinuria. According to some scholars, diabetic nephropathy has always been accompanied by PDR, while albuminuria and proteinuria have been important independent predicators of development and progression of DR [31][32][33][34].…”

“…When it comes to DR, authors claimed that the effect of this factor was not so obvious [36,37]. It was shown that in patients treated with insulin, higher cholesterol concentrations were related to an increased occurrence of hard exudates [34]. In the Early Treatment Diabetic Retinopathy Study (ETDRS) it was confirmed that every increase in cholesterol concentration by 10% increased the number of hard exudates by 50% in older DM1 patients [37,38].…”

Systemic and ocular diseases associated with the development of diabetic macular edema among Japanese patients with diabetes mellitus

“…This finding might be explained by improvements in the control of systemic risk factors in patients with DM. DM-related severe ocular complications are one of the main causes [36]. DM has been identified as an important risk factor for osteoporosis-associated fracture [37,38].…”

“…Accordingly, there is a clear relationship between systemic microvasculature damage and ocular complications. Yamamoto et al reported that diabetes, proteinuria and glomerular filtration rate were associated with higher risks of diabetic eye diseases, including DME [ 36 ].…”