Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 7;3(5):808-815.e1.
doi: 10.1016/j.xkme.2021.04.018. eCollection 2021 Sep-Oct.

Retinopathy and Risk of Kidney Disease in Persons With Diabetes

Jingyao Hong  1 , Aditya Surapaneni  1 , Natalie Daya  1 , Elizabeth Selvin  1 , Josef Coresh  1 , Morgan E Grams  1 , Shoshana H Ballew  1
Affiliations

Retinopathy and Risk of Kidney Disease in Persons With Diabetes

Jingyao Hong et al. Kidney Med. .

Abstract

Rationale & objective: Retinopathy and chronic kidney disease (CKD) are typically considered microvascular complications of diabetes, and cardiovascular and cerebrovascular diseases are considered macrovascular complications; however, all may share common pathological mechanisms. This study quantified the association of retinopathy with risk of kidney disease and compared with the association with cardiovascular disease in persons with diabetes.

Study design: Retrospective cohort study.

Setting & participants: 1,759 participants in the ARIC study who had diabetes at visit 4 and underwent retinal examination at visit 3.

Exposure: Retinopathy.

Outcome: Prevalent CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2), prevalent albuminuria (urinary albumin-creatinine ratio [UACR] > 30 mg/g), incident CKD, incident end-stage kidney disease (ESKD), incident coronary heart disease (CHD), and incident stroke.

Analytical approach: The cross-sectional association of retinopathy with prevalent CKD and albuminuria was assessed by logistic regression. The associations between retinopathy, incident CKD, incident ESKD, incident CHD, and incident stroke were examined using Cox proportional hazards models. Seemingly unrelated regression was used to compare the strength of association between retinopathy and outcomes.

Results: During the median follow-up period of 14.2 years, 723 participants developed CKD, and there were 109 ESKD events, 399 CHD events, and 196 stroke events. Compared with the participants without retinopathy, participants with retinopathy were more likely to have reduced eGFR (OR, 1.56 [95% CI, 1.09-2.23]) and UACR > 30 mg/g (OR, 1.61 [95% CI, 1.24-2.10]). Retinopathy was associated with risk of incident CKD (HR, 1.22 [95% CI, 1.02-1.46]), ESKD (HR, 1.69 [95% CI, 1.11-2.58]), CHD (HR, 1.46 [95% CI, 1.15-1.84]), and stroke (HR, 1.43 [95% CI, 1.03-1.97]). A stronger relationship was found between retinopathy and CHD when compared with retinopathy and CKD (P = 0.03); all other associations were similar.

Limitations: Retinal examination and kidney measurements were taken at different visits.

Conclusions: The presence of retinopathy was associated with higher prevalence of kidney disease and higher risk of incident CKD, ESKD, and CHD. These results may suggest that a similar mechanism underlies the development of retinopathy and other adverse outcomes in diabetes.

Keywords: Cardiovascular disease; chronic kidney disease; diabetes; end-stage kidney disease; retinopathy.

PubMed Disclaimer

Figures

None
Graphical abstract
Figure 1
Figure 1
Survival curves of (A) CKD and (B) ESKD in participants, by presence versus absence of retinopathy. Survivor function graphs are based on Cox proportional hazards model. Models are adjusted for visit 4 variables of age, sex, race and center, BMI, smoking status, hypertension, eGFR, UACR, total cholesterol, use of statin, fasting glucose, use of insulin, and duration of diabetes from visit 1 to visit 4. Abbreviations: BMI, body mass index; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease; UACR, urinary albumin-creatinine ratio.
Figure 2
Figure 2
Survival curves of (A) CHD and (B) stroke in participants, by presence versus absence of retinopathy. Survivor function graphs are based on Cox proportional hazards model. Models are adjusted for visit 4 variables of age, sex, race and center, BMI, smoking status, hypertension, eGFR, UACR, total cholesterol, use of statin, fasting glucose, use of insulin and duration of diabetes from visit 1 to visit 4. Abbreviations: BMI, body mass index; CHD, coronary heart disease; eGFR, estimated glomerular filtration rate; UACR, urinary albumin-creatinine ratio.
See this image and copyright information in PMC

References

    1. International Diabetes Federation . 8th ed. International Diabetes Federation; 2017. IDF Diabetes Atlas.
    1. World Health Organization . WHO; 2016. Global Report on Diabetes.
    1. Centers for Disease Control and Prevention . Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2017. National Diabetes Statistics Report, 2017.
    1. United States Renal Data System . National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2016. 2016 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States.
    1. Kang D., Kanellis J., Hugo C. Role of the microvascular endothelium in progressive renal disease. J Am Soc Nephrol. 2002;13(3):806–816. doi: 10.1681/ASN.V133806. - DOI - PubMed