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Kidney Week

Abstract: FR-PO465

Impact of Diabetic Retinopathy and Diabetic Kidney Disease on All-Cause and Cardiovascular Mortality

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical


  • Sabanayagam, Charumathi, Singapore Eye Research Institute, Singapore, Singapore
  • Chee, Miao li, Singapore Eye Research Institute, Singapore, Singapore
  • Mohamed, Riswana, Singapore Eye Research Institute, Singapore, Singapore
  • Cheng, Ching-Yu, Singapore Eye Research Institute, Singapore, Singapore
  • Lim, Su-chi, Khoo Teck Puat Hospital, Singapore, Singapore
  • Tai, E shyong, National University of Singapore, Singapore, Singapore
  • Coffman, Thomas M., Duke University Medical Center, Durham, North Carolina, United States
  • Wong, Tien Yin, Singapore Eye Research Institute, Singapore, Singapore

The relationship between diabetic microvascular complications including diabetic retinopathy (DR), and diabetic kidney disease (DKD), and mortality in populations are not clear.


We examined the association between DR, DKD and mortality among 2880 Chinese, Malay and Indian adults (aged 40-80 years) with diabetes who participated in the Singapore Epidemiology of Eye Diseases study (baseline, 2004-2011). Information on mortality was obtained by linkage with National Death Registry until May 2017. DR was ascertained from retinal photographs and DKD from estimated glomerular filtration rate (≤60 ml/min/1.73 m2). Associations of DR and DKD with each outcome separately and jointly were examined using multivariate Cox proportional hazards regression models.


Over a median follow-up of 8.8 years, 580 deaths occurred (20.1%) of which 254 (8.8%) were due to CVD. DR and DKD were significantly associated with all-cause and CVD mortality separately and jointly. In joint models including both DR and DKD, 58.9% had neither DR nor DKD (DR-DKD-), 11.8% had DKD alone (DKD+ DR-), 21% had DR alone (DR+ DKD-), and 8.3% had both DR and DKD (DKD+DR+). Beyond the background risk (12% and 4.2% in DR-DKD-), excess risk of absolute all-cause and CVD mortality were 27.1%, 12.6% in DKD+ DR-, 6.5%, 5.2% in DR+DKD- and 5% and 5.3% in DKD+DR+. In multivariable models, compared to DR-DKD-, hazard ratio (95% confidence interval) of all-cause and CVD mortality were 1.89 (1.40-2.57), 2.26 (1.42-3.61) for DKD+ DR- , 1.38 (1.03-1.86), 1.64 (1.06-2.56) for DR+DKD-; 2.76 (2.05-3.72), 3.41 (2.19-5.32) for DKD+DR+. No significant interaction was observed between DR and DKD on additive or multiplicative scale for either outcome (all p>0.1).


Our results suggest that risks of all-cause and CVD deaths were significantly higher in those with DKD and DR, but DKD largely contributed to the excess risk. Our findings emphasize the need for assessing the presence of DR and DKD in diabetic populations to assess mortality risk associated with type 2 diabetes.


  • Government Support - Non-U.S.