Abstract: SA-PO555
Diabetic Retinopathy and the Risk of Renal, Cardiovascular, and Death Events: Results from a Longitudinal Japanese Cohort of 232 Patients with Type 2 Diabetes and Biopsy-Proven Diabetic Kidney Disease
Session Information
- Diabetic Kidney Disease: Pathology, Epidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Yamanouchi, Masayuki, Toranomon Hospital, Tokyo, Japan
- Hoshino, Junichi, Toranomon Hospital, Tokyo, Japan
- Ubara, Yoshifumi, Toranomon Hospital, Tokyo, Japan
Background
The predictive value of diabetic retinopathy on end-stage kidney disease (ESKD), cardiovascular disease (CVD), and death has not been fully addressed in patients with type 2 diabetes and diabetic kidney disease.
Methods
We studied 232 patients with type 2 diabetes and biopsy-proven diabetic kidney disease, stratified into five groups according to the International Clinical Disease Severity Scale for Diabetic Retinopathy. The association between retinal grading and kidney lesions was examined. The risks of ESKD, CVD, and all-cause death, were explored using Cox regression analyses adjusted for known risk demographic and clinical variables. The incremental prognostic value of ESKD was assessed by adding diabetic retinopathy to the clinical variables.
Results
The severity scale of diabetic retinopathy positively correlated with all scores of renal lesions, especially with the glomerular-based classification (r =0.41), and scores of interstitial fibrosis (r =0.41) and diffuse lesion (r =0.47). During median follow-up of 5.7 years, 114 patients developed ESKD, 45 patients developed CVD, and 42 patients died, respectively. Compared to patients with no apparent retinopathy, the adjusted hazard ratio (HR) for ESKD were 1.96 (95% confidence interval (CI), 0.62-6.17) for patients with mild non-proliferative diabetic retinopathy (NPDR), 3.10 (95% CI, 1.45-6.65) for patients with moderate NPDR, 3.03 (95% CI, 1.44-6.37) for patients with severe NPDR, and 3.43 (95% CI, 1.68-7.03) for patients with proliferative diabetic retinopathy, respectively. The risks of CVD and all-cause mortality were not shown to be significant. The global chi-square statistic increased from 155.21 to 164.48 (p <0.001) with the addition of diabetic retinopathy severity scale to the clinical model alone.
Conclusion
Diabetic retinopathy appeared to be associated with developing ESKD but not with developing CVD or all-cause mortality. Since diabetic retinopathy and diabetic kidney disease share the same magnitude of microvascular changes, diabetic retinopathy may predict renal prognosis in patients with diabetic kidney disease.