Stratifying Renal Risk and Retinal Involvement in South Indian Type 2 Diabetic Patients: Using the Kdigo Classification

Abstract

Aim: To stratify the renal risk using estimated Glomerular Filtration Rate (eGFR) and albuminuria based on Kidney Disease Improving Global Outcome (KDIGO) classification and its association with the degree of Diabetic Retinopathy (DR) among people with Type 2 Diabetes (T2DM) in South India. Methods: A total of 3426 (2193:1233) subjects with T2DM who underwent Fundus Photography and Fundus Fluorescent Angiography for DR, estimated Glomerular Filtration Rate (eGFR) and renal function test for assessing renal function were included in the cross -sectional study. Based on eGFR and albuminuria, patients were grouped into Low Risk (LR), Moderately increased Risk (MR), High Risk (HR) and Very High Risk (VHR) categories as per KDIGO classification. Demographic, anthropometric, and biochemical details were recorded accordingly. Results: Among the study population (n=3426) 61.4% were in LR group followed by 17.2 % in MR, 14.3% in HR and 7.2% in VHR group respectively. Among different risk categories, significant difference (p<0.001) was observed among LR, MR, HR and VHR group in age, duration of diabetes, systolic and diastolic blood pressure, HbA1c, urea, creatinine and eGFR. eGFR significantly declined as the risk categories in KDIGO increased. Among the study population, 27.32% (n = 936) had different degree of DR. Significant difference in eGFR was observed among patients with and without DR. As the severity of the DR increases, renal risk categories based on KDIGO classification also increased. High concordance was observed between different degrees of DR and KDIGO classification. Conclusion:In T2DM subjects, there is a significant association between DR and renal risk category using KDIGO classification. Thus, KDIGO classification can be used to stratify the renal and retinal risk in T2DM than mere albuminuria or eGFR.

Determinants and Stratification of Microvascular Complications of Type 2 Diabetes Mellitus

“…Our study showed a low, positive correlation between diabetic retinopathy and diabetic nephropathy. This finding was consistent with the study conducted by Anitharani et al [13]. In a study conducted by Kotlarsky et al, a statistically significant relationship was observed between diabetic retinopathy and diabetic neuropathy, displaying a unidirectional correlation attributed to the chronological order in which diabetic neuropathy occurs before diabetic retinopathy.…”

“…eGFR was measured using the CKD-EPI equation [12]. Based on the study conducted by Rani et al, we divided our study population into low-risk (LR) (green), moderate-risk (MR) (yellow), high-risk (HR) (orange), and very highrisk (VHR) (red) according to the KDIGO classification, based on eGFR and urinary albumin values [13].…”