Abstract: FR-PO277
Progression of Diabetic Retinopathy and Declining Renal Function in Patients with Type 2 Diabetes
Session Information
- CKD: Epidemiology and Risk Factors
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Cho, Ajin, Hallym university Kangnam Sacred Heart Hospital, Seoul, Korea (the Republic of)
- Noh, Jung-woo, Chun & Cho's Medical Clinic & Dialysis Center, Seoul, Korea (the Republic of)
- Kim, Juhee, Department of Internal Medicine-Nephrology, Gangnam Sacred Heart Hospital, Korea, Republic of, Seoul, Korea (the Republic of)
Background
Diabetes mellitus (DM) causes microvascular complications that are major causes of morbidity and mortality. Diabetic retinopathy (DR) is an important microvascular complication and is the most common cause of preventable blindness in adults. Diabetic nephropathy is a leading cause of chronic kidney disease (CKD). The retina and the kidney share similar microvascular complications resulting from DM. Although many cross-sectional studies have reported associations between renal function and prevalent DR, this might be the result of enrolling patients with long disease durations. Therefore in this study, we investigated how declining renal function affects on DR progression of patients with type 2 diabetes and whether patients with decreased renal function need evaluation of DR status.
Methods
We enrolled 1527 patients with type 2 diabetes from the diabetes clinic in the Department of Endocrinology of Kangnam Sacred Heart Hospital who underwent fundus photographic examinations for DR and whose renal profiles were studied between August 2006 and February 2014. The presence of DR was assessed by an expert ophthalmologist using dilated fundoscopy. Patients were classified into the following categories: (1) normal: no apparent sign of DR; (2) non-proliferative DR (NPDR); (3) proliferative DR (PDR) according to the Global Diabetic Retinopathy Project Group. The presence and severity of DR in a participant were determined based on the eye showing the worst retinopathy. DR progression was defined as a change either from no DR progress to NPDR or from NPDR to PDR.
Results
The baseline prevalence of non-proliferative DR (NPDR) and proliferative DR (PDR) was 26.5% and 14.7%, respectively. The mean period for follow-up fundus exams was 4.0 ± 2.0 years. Among 1303 patients with no DR and NPDR, 134 (10.3%) patients progressed to NPDR or PDR. The progression group had longer duration of diabetes, higher fasting plasma glucose, higher HbA1c and a higher rate of > 20% decline in eGFR during the follow-up period. After multivariate analysis, > 20% decline in eGFR was an independent risk factor for progression of DR in patients with NPDR.
Conclusion
Decrease of renal function was associated with progression of DR, especially in patients with NPDR. This result supports the notion that an individualized screening schedule according to the individual patient’s risk might be needed.