Hsieh YT, et al. - A scrutiny was carried out of the correlation between chronic kidney disease with the development of diabetic retinopathy (DR) and diabetic macular edema (DME) in type 2 diabetes. The results divulged a connection between the development of PDR in patients with type 2 diabetes with abnormal renal profiles at baseline, including a high serum creatinine level, low estimated glomerular filtration rate, and high urinary albumin/creatinine ratio (ACR). It was perceived that a high baseline urinary ACR was related to DME. Furthermore, the findings shed light on the association between abnormal mean follow-up renal profiles with new-onset proliferative DR (PDR), after adjusting for baseline values. Aggressive treatment for chronic kidney disease could aid in preventing the deterioration of DR.

Methods

• The design of this trial was an 8-year prospective cohort study.
• It was carried out in 2 medical centers in Taiwan.
• Researchers enrolled 2,135 patients with type 2 diabetes.
• The exposures constituted the baseline and mean follow-up renal profiles including serum creatinine level, estimated glomerular filtration rate (eGFR), and urinary albumin/creatinine ratio (ACR).
• The detection of diabetic retinopathy and DME via nonmydriatic fundus photography served as the main outcome measure.
• Through the Cox regression analyses, the hazard ratios (HRs) for the renal profiles of new-onset DR, proliferative DR, and DME were computed.

Results

• The mean (SD) age of the enrollees was 63.4 (11.9) years and 1,025 (48%) were women.
• A connection was revealed between a higher serum creatinine level (HR of 2.358 for an increase of 1 mg/dL [to convert to micromoles per liter, multiply by 76.25]; 95% CI, 1.901-2.924; P < .001), an estimated glomerular filtration rate of less than 60 mL/min/1.73m² (40-60: HR, 2.235; 95% CI, 1.351-4.035; P=.002; 30-45: HR, 2.625; 95% CI, 1.436-4.798; P=.002; <30: HR, 5.488; 95% CI, 2.739-10.993; P < .001), and a urinary albumin to creatinine ratio (ACR) of more than 30 mg/g (31-300: HR, 3.202; 95% CI, 2.029-5.053; P < .001; >300: HR, 6.652; 95% CI, 3.922-11.285; P < .001) at baseline, with the development of proliferative DR.
• Furthermore, a baseline urinary ACR of more than 30 mg/g (31-300: HR, 1.563; 95% CI, 1.078-2.267; P=.02; >300: HR, 2.707; 95% CI, 1.640-4.470; -2.707; P < 0.001) appeared to be correlated with the development of DME.
• The mean follow-up renal profiles, including a higher serum creatinine level (HR, 2.369 per mg/dL; 95% CI, 1.704-3.293; P < .001), an estimated glomerular filtration rate of less than 30 mL/min/1.73m² (HR, 4.215; 95% CI, 1.265-14.039; P=.02), and a urinary ACR of more than 30 mg/g (31-300: HR, 2.344; 95% CI, 1.200-4.503; P=.01; >300: HR, 4.193; 95% CI, 1.638-10.735; P=.003) remained associated with new-onset PDR during the follow-up periods, after adjusting the baseline values.