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. 2023 Jul 6;16(10):1656-1663.
doi: 10.1093/ckj/sfad142. eCollection 2023 Oct.

The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes

Sheila Bermejo  1   2   3 , Ester González  4 , Katia López-Revuelta  5 , Meritxell Ibernon  6 , Diana López  7 , Adoración Martín-Gómez  8 , Rosa Garcia-Osuna  9 , Tania Linares  10 , Montserrat Díaz  11 , Nàdia Martín  12 , Xoana Barros  12 , Helena Marco  11   13 , Maruja Isabel Navarro  13 , Noemí Esparza  14 , Sandra Elias  15 , Ana Coloma  16   17 , Nicolás Roberto Robles  18 , Irene Agraz  1   2 , Esteban Poch  19   20 , Lida Rodas  19   20 , Víctor Lozano  19   20 , Beatriz Fernández-Fernández  21 , Eduardo Hernández  4 , Maria Isabel Martínez  5 , Ramona Ionela Stanescu  5 , José Pelayo Moirón  7 , Núria García-Fernández  7 , Marian Goicoechea  10 , Francesca Calero  11 , Josep Bonet  13 , Fernando Liaño  22 , Julio Pascual  3 , Oriol Bestard  1   2 , Manuel Praga  4 , Xavier Fulladosa  17 , María José Soler  1   2   3
Affiliations

The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes

Sheila Bermejo et al. Clin Kidney J. .

Abstract

Background: Up to 50-60% of patients with diabetes have non-diabetic kidney disease (NDKD) on kidney biopsy. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the kidney outcomes and survival in patients with biopsy diagnoses of DN and NDKD according to the presence of DR.

Methods: We conducted an observational, multicentre and retrospective study of the pathological findings of renal biopsies from 832 consecutive patients with diabetes from 2002 to 2014 from 18 nephrology departments. The association of DR with kidney replacement therapy (KRT) or survival was assessed by Kaplan-Meier and Cox regression analyses.

Results: Of 832 patients with diabetes and renal biopsy, 768 had a retinal examination and 221/768 (22.6%) had DR. During a follow-up of 10 years, 288/760 (37.9%) patients with follow-up data needed KRT and 157/760 (20.7%) died. The incidence of KRT was higher among patients with DN (alone or with NDKD) and DR [103/175 (58.9%)] than among patients without DR [88/216 (40.7%), P < .0001]. The incidence of KRT was also higher among patients with only NDKD and DR than among those without DR [18/46 (39.1%) versus 79/331 (23.9%), P < .0001]. In multivariate analysis, DR or DN were independent risk factors for KRT {hazard ratio [HR] 2.48 [confidence interval (CI) 1.85-3.31], P < .001}. DN (with or without DR) was also identified as an independent risk factor for mortality [HR 1.81 (CI 1.26-2.62), P = .001].

Conclusions: DR is associated with a higher risk of progression to kidney failure in patients with histological DN and in patients with NDKD.

Keywords: diabetes mellitus; diabetic kidney disease; diabetic nephropathy; kidney biopsy; type 2 diabetes.

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Conflict of interest statement

S.B. reports honorarium for conferences, consulting fees and advisory boards from AstraZeneca, Boehringer, Bayer and Mundipharma. M.J.S. reports personal fees from Novo Nordisk, Jansen, Mundipharma, AstraZeneca, Esteve, Fresenius, Ingelheim Lilly, Vifor, ICU, Pfizer, Bayer, Travere Therapeutics and GE Healthcare and grants and personal fees from Boehringer Ingelheim, outside the current study. N.M. reports honoraria from Alexion and GSK. N.G.-F. paticipates on scientific advisory virtual of Mundipharma, honoraria for lectures of Astellas and medical Statistics Consulting and payment for expert testimony of Baxter, Viforpharma and Fresenius. B.F.-F. has received grants from Esteve and Astrazeneca and have worked for Cátedra UAM-mundipharma. B.F.-F. has received consultancy or speaker fees or travel support from Astrazeneca, Bayer, Menarini, Novo-Nordisk BoeringerInheilm and Mundipharma. B.F.F is Editor for Nefroplus. B.F.-F. has received travel support from Astrazeneca, Bayer, Menarini, Novo-Nordisk BoeringerInheilm and Mundipharma. B.F.-F. has been advisor for Astrazeneca, Bayer, Menarini, Novo-Nordisk Boeringer Inheilm and Mundipharma. M.P. reports consulting fees and payment for honoraria from Alexion, Novartis, Otsuka, Vifor, GSK, Travere. M.J.S. is Editor Emeritus of CKJ. The rest of authors have no conflicts of interest to declare.

Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Flowchart of patients included in the present study: 768 with retinal study data were included and 760 of these had information on KRT and mortality outcomes.
Figure 2:
Figure 2:
Analysis of KRT outcomes according to the presence of (A) DR, (B) histological diagnosis and (C) the presence of DR or DN versus neither DR nor DN.
Figure 3:
Figure 3:
Analysis of patient survival according to the presence of (A) DR, (B) histological diagnosis and (C) the presence of DR or DN versus neither DR nor DN.
See this image and copyright information in PMC

References

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