Abstract: FR-PO655

Association between Severity of Diabetic Retinopathy and Renal Pathology or Renal Prognosis in Patients with Biopsy-Proven Diabetic Nephropathy in Type 2 Diabetes Mellitus

Session Information

Category: Diabetes

  • 502 Diabetes Mellitus and Obesity: Clinical

Authors

  • Morimoto, Katsuhiko, Nara Medical University, Kashihara, Japan
  • Samejima, Ken-ichi, Nara Medical University, Kashihara, Japan
  • Matsui, Masaru, Nara Medical University, Kashihara, Japan
  • Kanki, Tomoko, Nara Medical University, Kashihara, Japan
  • Nishimoto, Masatoshi, Nara Medical University, Kashihara, Japan
  • Tagawa, Miho, Nara Medical University, Kashihara, Japan
  • Akai, Yasuhiro, Nara Medical University, Kashihara, Japan
  • Saito, Yoshihiko, Nara Medical University, Kashihara, Japan
Background

Diabetic nephropathy and retinopathy are generally believed to develop concomitantly. However, much remains unclear about the association between renal pathology andretinopathy as renal biopsy is rarely indicated.

Methods

This is a retrospective observational study. Inclusion criteria were patients with type 2 diabetes, biopsy-proven diabetic nephropathy, and evaluation for retinopathy by ophthalmologists from 1984 to 2014. Exposure of interest was severity of retinopathy by the modified Davis and the Scheie Classification. Outcome variable was development of end-stage renal disease (ESRD). Statistical analyses were performed using Cox regression model. Correlation between severity of retinopathy and renal pathology were examined using Spearman’s rank correlation.

Results

Data for 376 patients were available, Mean age was 57.5 years. Retinopathy was found in 168 (44.7%). During mean follow-up of 9.4 years, ESRD developed in 67. Renal prognosis was significantly poorer in the group with retinopathy. In terms of modified Davis classification, more severe retinopathy indicated poorer renal prognosis (log-rank p<0.001). In Cox regression analysis, severity of retinopathy was an independent risk factor for the development of ESRD (Table). Positive correlations with retinopathy were observed for diffuse glomerular lesions (ρ=0.48, p<0.001), nodular lesions (ρ=0.50, p<0.001),interstitial fibrosis and tubular atrophy (ρ=0.36, p<0.001), and arteriolar hyalinosis (ρ=0.34, p<0.001).

Conclusion

Only about half of patients with biopsy-proven diabetic nephropathy had retinopathy. The severity of retinopathy was an independent predictor of progression of nephropathy.

Relationship between diabetic retinopathy and ESRD (Cox regression)
 Adjusted HR95% CIP value
Non-proliferative retinopathy3.511.68 to 7.64<0.001
Preproliferative retinopathy3.761.35 to 10.10.01
Proliferative retinopathy15.56.33 to 38.9<0.001

Covariates included age, sex, eGFR, systolic blood pressure, proteinuria (g/gCr), HbA1c.