Korean J Ophthalmol.  2014 Oct;28(5):373-378. 10.3341/kjo.2014.28.5.373.

Diabetic Retinopathy Risk Factors: Plasma Erythropoietin as a Risk Factor for Proliferative Diabetic Retinopathy

Affiliations
  • 1Department of Ophthalmology, Birjand University of Medical Science, Birjand, Iran. yaqubi@bums.ac.ir
  • 2Social Detrimental Health Research Center, Birjand, Iran.

Abstract

PURPOSE
The purpose of this study was to evaluate whether any stage of diabetic retinopathy (DR) is associated with levels of plasma erythropoietin and other plasma parameters.
METHODS
It was examined a representative sample of 180 type 2 diabetes patients aged 40 to 79 years. Ophthalmic examination including a funduscopic examination, performed by an experienced ophthalmologist and the retinal finding were classified according to the grading system for diabetic retinopathy of ETDRS (Early Treatment Diabetic Retinopathy Study). It was measured the levels of plasma erythropoietin, cholesterol, triglyceride, apolipoproteins A and B, C-reactive protein, fasting blood glucose and hemoglobin A1C (HbA1C) in 88 DR patients and 92 controls without DR. Risk factors correlated with DR were compared between groups.
RESULTS
The study group of 180 patients included 72 males and 108 females. The mean age of the patients with and without DR was 57.36 ± 8.87 years and 55.33 ± 8.28 years, respectively. Of the 88 patients with DR, only 9 (10%) had proliferative DR and the rest suffered from non-proliferative DR. The mean plasma levels of erythropoietin in proliferative DR group showed a significant difference in comparison to other groups. The mean plasma levels of cholesterol, triglyceride, apolipoproteins A and B, C-reactive protein, and fasting blood glucose were not significantly different in the three groups except for HbA1C. The absolute relative risk (ARR) also showed that erythropoietin was an increasing risk for proliferative DR (ARR, 1.17; 95% confidence interval, 1.060 to 1.420; odds ratio,1.060).
CONCLUSIONS
Of the factors studied, erythropoietin level showed significant increase in proliferative DR group. The stepwise raised in mean plasma erythropoietin level which demonstrates significant correlation with proliferative DR versus remaining two groups, will be an indication of its role in proliferative DR.

Keyword

Diabetic retinopathy; Risk factors; Type 2 diabetes mellitus

MeSH Terms

Adult
Aged
Blood Glucose/metabolism
Cholesterol/blood
Cross-Sectional Studies
Diabetes Mellitus, Type 2/complications
Diabetic Retinopathy/*blood/diagnosis/*epidemiology
Enzyme-Linked Immunosorbent Assay
Erythropoietin/*blood
Female
Fluorescein Angiography
Hemoglobin A, Glycosylated/metabolism
Humans
Male
Middle Aged
Risk Factors
Blood Glucose
Cholesterol
Erythropoietin
Hemoglobin A, Glycosylated

Reference

1. Riaz S. Diabetes mellitus. Sci Res Essay. 2009; 4:367–373.
2. Chatziralli IP, Sergentanis TN, Keryttopoulos P, et al. Risk factors associated with diabetic retinopathy in patients with diabetes mellitus type 2. BMC Res Notes. 2010; 3:153.
3. Mallika PS, Lee PY, Cheah WL, et al. Risk factors for diabetic retinopathy in diabetics screened using fundus photography at a primary health care setting in East Malaysia. Malays Fam Physician. 2011; 6:60–65.
4. Hadhoud KM, El Hefni AM, Salem IM, et al. Monocyte chemotactic protein-1, nitrite and C-reactive protein in diabetic retinopath. J Am Sci. 2012; 8:109–118.
5. Van Geest RJ, Lesnik-Oberstein SY, Tan HS, et al. A shift in the balance of vascular endothelial growth factor and connective tissue growth factor by bevacizumab causes the angiofibrotic switch in proliferative diabetic retinopathy. Br J Ophthalmol. 2012; 96:587–590.
6. Diskin CJ, Stokes TJ, Dansby LM, et al. A hypothesis: can erythropoietin administration affect the severity of retinopathy in diabetic patients with renal failure? Am J Med Sci. 2007; 334:260–264.
7. Takagi H, Watanabe D, Suzuma K, et al. Novel role of erythropoietin in proliferative diabetic retinopathy. Diabetes Res Clin Pract. 2007; 77:S62–S64.
8. Izuora KE, Chase HP, Jackson WE, et al. Inflammatory markers and diabetic retinopathy in type 1 diabetes. Diabetes Care. 2005; 28:714–715.
9. Dizdarevic A, Alikadic-Husovic A, Jusufovic V. Risk factors and diabetic retinopathy. Med Glas (Zenica). 2012; 9:104–106.
10. Khodeir SA, Abd El Raouf YM, Farouk G, El-Bradey M. Detection of circulating microparticles in patients with proliferative diabetic retinopathy. Life Sci J. 2012; 9:204–209.
11. Chait A, Montes VN. Apolipoproteins and diabetic retinopathy. Diabetes Care. 2011; 34:529–531.
12. Del Canizo Gomez FJ, Fernandez Perez C, Moreno Ruiz I, et al. Microvascular complications and risk factors in patients with type 2 diabetes. Endocrinol Nutr. 2011; 58:163–168.
13. Lim LS, Tai ES, Mitchell P, et al. C-reactive protein, body mass index, and diabetic retinopathy. Invest Ophthalmol Vis Sci. 2010; 51:4458–4463.
14. Meleth AD, Agron E, Chan CC, et al. Serum inflammatory markers in diabetic retinopathy. Invest Ophthalmol Vis Sci. 2005; 46:4295–4301.
15. Aso Y, Okumura K, Takebayashi K, et al. Relationships of plasma interleukin-18 concentrations to hyperhomocysteinemia and carotid intimal-media wall thickness in patients with type 2 diabetes. Diabetes Care. 2003; 26:2622–2627.
16. Heydari B, Yaghoubi G, Yaghoubi MA, Miri MR. Prevalence and risk factors for diabetic retinopathy: an Iranian eye study. Eur J Ophthalmol. 2012; 22:393–397.
17. Lim MC, Lee SY, Cheng BC, et al. Diabetic retinopathy in diabetics referred to a tertiary centre from a nationwide screening programme. Ann Acad Med Singapore. 2008; 37:753–759.
18. Jee D, Lee WK, Kang S. Prevalence and risk factors for diabetic retinopathy: the Korea National Health and Nutrition Examination Survey 2008-2011. Invest Ophthalmol Vis Sci. 2013; 54:6827–6833.
19. Wang ZY, Zhao KK, Zhao PQ. Erythropoietin therapy for early diabetic retinopathy through its protective effects on retinal pericytes. Med Hypotheses. 2011; 76:266–268.
20. Watanabe D, Suzuma K, Matsui S, et al. Erythropoietin as a retinal angiogenic factor in proliferative diabetic retinopathy. N Engl J Med. 2005; 353:782–792.
21. Mitsuhashi J, Morikawa S, Shimizu K, et al. Intravitreal injection of erythropoietin protects against retinal vascular regression at the early stage of diabetic retinopathy in streptozotocin-induced diabetic rats. Exp Eye Res. 2013; 106:64–73.
22. Chaturvedi N, Sjoelie AK, Porta M, et al. Markers of insulin resistance are strong risk factors for retinopathy incidence in type 1 diabetes. Diabetes Care. 2001; 24:284–289.
23. Mohan N, Monickaraj F, Balasubramanyam M, et al. Imbalanced levels of angiogenic and angiostatic factors in vitreous, plasma and postmortem retinal tissue of patients with proliferative diabetic retinopathy. J Diabetes Complications. 2012; 26:435–441.
24. Jonas JB, Neumaier M. Erythropoietin levels in aqueous humour in eyes with exudative age-related macular degeneration and diabetic retinopathy. Clin Experiment Ophthalmol. 2007; 35:186–187.
25. Uparkar M, Kaul S. Diabetic macular oedema and erythropoietin. Eye (Lond). 2009; 23:1747–1748.
26. Zhu XF, Zou HD. PEDF in diabetic retinopathy: a protective effect of oxidative stress. J Biomed Biotechnol. 2012; 2012:580687.
27. Antonetti DA, Klein R, Gardner TW. Diabetic retinopathy. N Engl J Med. 2012; 366:1227–1239.
28. Muni RH, Kohly RP, Lee EQ, et al. Prospective study of inflammatory biomarkers and risk of diabetic retinopathy in the diabetes control and complications trial. JAMA Ophthalmol. 2013; 131:514–521.
Full Text Links
  • KJO
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr