Kidney Week

Abstract: SA-PO548

Diabetic Retinopathy and Progression of Diabetic Kidney Disease in Asians

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

• Sabanayagam, Charumathi, Singapore Eye Research Institute, Singapore, Singapore

Charumathi Sabanayagam,

• Ganguly, Rehena sultana, Duke-NUS Medical School, Singapore, Singapore

Rehena sultana Ganguly,

• Nusinovici, Simon, Singapore Eye Research Institute, Singapore, Singapore

Simon Nusinovici,

• Lim, Cynthia Ciwei, Singapore General Hospital, Singapore, Singapore

Cynthia Ciwei Lim,

• Tan, Gavin, Singapore Nationa Eye Centre & Singapore Eye Research Institute, Singapore, Singapore

Gavin Tan,

• Wong, Tien Yin, Singapore Eye Research Institute, Singapore, Singapore

Tien Yin Wong,

Group or Team Name

• DYNAMO

Background

Diabetic kidney disease (DKD) and diabetic retinopathy (DR) share similar risk factors and pathogenic mechanisms. We examined the prospective relationship between DR and incidence and progression of DKD in a multi-ethnic Asian population in Singapore.

Methods

We analysed data from 2981 Chinese, Malay and Indian adults with diabetes aged 17-90 years who attended annual screening visits (3-6 visits) at primary care clinics from 2010-2015 as part of the Singapore Integrated DR Screening Program (SiDRP). DR (n=297) was assessed from retinal photographs graded using a standard protocol and defined as presence of mild/moderate/severe DR. Incident DKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m²+ 25% decrease in eGFR at follow-up in those with eGFR≥60 at baseline and DKD progression as decline in eGFR by ≥30% from baseline to follow-up. We examined the association between DR and incidence/progression of DKD using logistic regression models adjusted for age, sex, ethnicity, systolic blood pressure (SBP), baseline eGFR, HbA1c, and duration of diabetes. We assessed if addition of DR improved prediction of DKD incidence or progression to traditional risk factor model by comparing the area under the receiver operating characteristic curve (AUC-ROC).

Results

The 3-5 year cumulative incidence and progression of DKD were 6.4% and 2.1%. Progression was significantly higher in Malays compared to Chinese and Indians (4.4%, 1.9%, 1.9%, p=0.04), incidence was not significantly different (7.1%, 6.8%, 3.8%, p=0.09). In multivariable models, DR was significantly associated with both incident and progressive DKD, (odds ratio [95% confidence interval] = 2.29 [1.50-3.48]) and 2.20 [1.18-4.09]) compared to no DR. Addition of DR, did not significantly improve prediction of incidence (AUC= 0.824 vs. 0.818, p=0.1) or progression (0.737 vs. 0.726, p=0.4) compared to traditional model, probably due to the small number of events. Other than DR, SBP and baseline eGFR were significant predictors for incidence and progression and Malay ethnicity for progression (all p<0.05).

Conclusion

We found that presence of DR was independently associated with increased risk of onset and progression of DKD. Our findings emphasize the importance of assessing DR status in DKD management and control of blood pressure in DR patients.

Funding

• Government Support - Non-U.S.