Rate and Determinants of Association Between Advanced Retinopathy and Chronic Kidney Disease in Patients With Type 2 Diabetes

Penno, Giuseppe; Solini, Anna; Zoppini, Giacomo; Orsi, Emanuela; Zerbini, Gianpaolo; Trevisan, Roberto; Gruden, Gabriella; Cavalot, Franco; Laviola, Luigi; Morano, Susanna; Nicolucci, Antonio; Pugliese, Giuseppe

doi:10.2337/dc12-0628

Cited by 115 publications

(121 citation statements)

References 30 publications

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“…[4][5][6][7][8]10,19,21,22,24,28,30,34,[38][39][40][42][43][44][47][48][49][50][51][52][53] 69 This is consistent with other genome-wide association studies in Caucasian and Mexican-American patients. 70,71 As the relationship between genetic polymorphisms and diabetic retinopathy is still a new and emerging field, some studies have demonstrated new associations between single nucleotide polymorphisms, but these studies have not yet been replicable.…”

supporting

confidence: 88%

“…Over time, these microvascular changes lead to narrowing and occlusion of the vascular lumina, and eventually cause inadequate perfusion of affected tissues leading to retinopathy and nephropathy. 48 These findings were corroborated by Penno et al 49 who reported that a high urine albumin-to-creatinine ratio of ≥300 mg/g was associated with diabetic retinopathy (OR=2.9; 95% CI, 2.1-4.0). Likewise, Rodríguez-Poncelas et al 50 found that increasing urine albumin-to-creatinine ratio was significantly correlated with rising diabetic retinopathy prevalence, and this association was significant even at urine albumin-to-creatinine levels of ≥10 mg/g (OR=1.2; 95% CI, 1.1-1.4).…”

Section: Chronic Kidney Diseasementioning

confidence: 57%

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Associations between diabetic retinopathy and systemic risk factors

Wat¹,

Wong²,

Wong³

2016

Hong Kong Med J

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Introduction: Diabetes mellitus is a systemic disease with complications that include sight-threatening diabetic retinopathy. It is essential to understand the risk factors of diabetic retinopathy before effective prevention can be implemented. The aim of this review was to examine the association between diabetic retinopathy and systemic risk factors.Methods: A PubMed literature search was performed up to May 2016 to identify articles reporting associations between diabetic retinopathy and systemic risk factors; only publications written in English were included. Relevant articles were selected and analysed. Results:Patients with diabetic retinopathy were more likely to have poor glycaemic control as reflected by a higher glycated haemoglobin, longer duration of diabetes, and use of insulin therapy for treatment. For other systemic risk factors, hypertension was positively associated with prevalence and progression of diabetic retinopathy. No clear association between obesity, hyperlipidaemia, gender, or smoking with diabetic retinopathy has been established as Associations between diabetic retinopathy and systemic risk factors IntroductionDiabetic retinopathy is the leading cause of blindness in adults living in developed countries. 1 Almost all patients with type 1 diabetes mellitus (DM) and more than 60% of patients with type 2 DM will develop some degree of retinopathy after a 20-year history of diabetes.2 It has also been well established that DM increases the risk of cardiovascular disease. 3Cheng et al 4 found that the prevalence of diabetic retinopathy associated with one, two, three, or four cardiometabolic risk factors was 16.0%, 17.6%, 21.3%, or 25.1%, respectively (P=0.001). This implies a relationship between systemic health conditions and diabetic retinopathy. In order to help identify and to prevent progression of this ophthalmic complication of diabetes, a better understanding of its association with systemic risk factors is necessary. MethodsA PubMed literature search was conducted up to May 2016 using the following key words: "diabetic retinopathy", "prevalence", "epidemiology", "systemic associations", "risk factors", "diabetic Hong Kong Med J 2016;22:589-99

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supporting

confidence: 88%

Section: Chronic Kidney Diseasementioning

confidence: 57%

Associations between diabetic retinopathy and systemic risk factors

Wat¹,

Wong²,

Wong³

2016

Hong Kong Med J

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“…The results suggest that DR could be associated not only with DN but also with CKD. 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.…”

Section: Discussionmentioning

confidence: 99%

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

Lee

Sobrin

Lee

et al. 2014

Invest. Ophthalmol. Vis. Sci.

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In DM patients, we observed a prevalence of 20.0% for any DR and 3.8% for proliferative diabetic retinopathy (PDR). Microalbuminuria prevalence was 19.3% and overt nephropathy prevalence was 5.5%. The risk factors of microalbuminuria were presence of hypertension; higher systolic blood pressure, serum hemoglobin A1c (HbA1c), and serum blood urea nitrogen level; as well as the presence of PDR. The risk factors of overt nephropathy were long duration of DM; high levels of HbA1c, systolic blood pressure, total cholesterol, and serum creatinine; as well as the presence of DR CONCLUSIONS: Proliferative diabetic retinopathy is associated with microalbuminuria and DR is associated with overt nephropathy in Korean DM patients. Our findings suggest that when an ophthalmologist finds the presence of DR or PDR, timely evaluation of the patient's renal status should be recommended.

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“…(El-Asrar et al, 2001; Romero-Aroca et al, 2010) Similar results have been obtained in studies examining the association of DR with decreased estimated glomerular filtration rate (eGFR), defined as <60ml/min/1.73m 2 . (Mottl et al, 2012; Penno et al, 2012) In a step-wise fashion, more severe retinopathy is increasingly associated with diabetic kidney disease. The presence of proliferative retinopathy carries an odds ratio for concurrent macroalbuminuria or decreased eGFR as high as 17-fold.…”

Section: Introductionmentioning

confidence: 99%

The degree of retinopathy is equally predictive for renal and macrovascular outcomes in the ACCORD Trial

Mottl

Pajewski

Fonseca

et al. 2014

Journal of Diabetes and its Complications

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Aims Diabetic retinopathy (DR) is associated with a higher risk of renal and cardiovascular events. We sought to compare the risk for renal versus cardiovascular (CV) outcomes, stratified by retinopathy severity. Methods ACCORD was a randomized trial of people with type 2 diabetes, at high-risk for CV disease. A subgroup (n=3,369 from 71 clinics) had stereoscopic fundus photographs graded centrally. Participants were stratified at baseline to moderate/severe DR or no/mild DR and were monitored for renal and CV outcomes at follow-up visits over 4 years. The composite renal outcome was comprised of serum creatinine doubling, macroalbuminuria, or end-stage renal disease. The composite CV outcome was the ACCORD trial primary outcome. Competing risk techniques were used to estimate the relative risk (RR) of renal versus CV composite outcomes within each DR stratum. Results The hazards ratio for doubling of serum creatinine and incident CV event in the moderate/severe DR versus no/mild DR strata were: 2.31 (95%CI: 1.25–4.26) and 1.98 (95%CI: 1.49–2.62), respectively. The RR of the two composite outcomes was highly similar in the no/mild DR stratum (adjusted RR at 4 years for CV versus renal events=0.96, 95%CI:0.72–1.28) and the moderate/severe DR stratum (adjusted RR=0.92, 95%CI:0.64–1.31). Conclusions Thus, in people with type 2 diabetes at high risk for cardiovascular disease, incident CV versus renal events was similar, irrespective of the severity of the DR. Further evaluation of the specificity of DR for microvascular versus macrovascular events in other populations is warranted.

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Rate and Determinants of Association Between Advanced Retinopathy and Chronic Kidney Disease in Patients With Type 2 Diabetes

Cited by 115 publications

References 30 publications

Associations between diabetic retinopathy and systemic risk factors

Associations between diabetic retinopathy and systemic risk factors

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

The degree of retinopathy is equally predictive for renal and macrovascular outcomes in the ACCORD Trial

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