J Yeungnam Med Sci.  2023 Apr;40(2):146-155. 10.12701/jyms.2022.00206.

Association of advanced chronic kidney disease with diabetic retinopathy severity in older patients with diabetes: a retrospective cross-sectional study

• Lee GW
• Lee CH
• Kim SG

• KMID: 2541940
• DOI: http://doi.org/10.12701/jyms.2022.00206

Abstract

Background
Despite the recent increasing trend in the prevalence of type 2 diabetes among older individuals, the relationship between diabetic retinopathy (DR) and chronic kidney disease (CKD) in these patients remains unclear. This study investigated the severity of renal dysfunction according to the degree of DR in older patients with type 2 diabetes.
Methods
A total of 116 patients with diabetes and CKD stage ≥3 who visited both the nephrology and ophthalmology outpatient departments between July 2021 and January 2022 were screened. There were 53 patients in the no DR group, 20 in the nonproliferative DR (NPDR) group, and 43 in the proliferative DR (PDR) group.
Results
DR severity was related to the deterioration of renal function. The proportion of patients with advanced CKD significantly increased with DR severity (p for trend <0.001). In the multivariate regression model adjusted for age of ≥80 years, male sex, poorly controlled diabetes, macroalbuminuria, insulin use, diabetes duration of ≥10 years, cerebrovascular accident, hypertension, hyperlipidemia, and cardiovascular disease history, the odds ratio compared with the no DR group was approximately 4.6 for the NPDR group and approximately 11.8 for the PDR group, which were both statistically significant (p=0.025 and p<0.001, respectively).
Conclusion
DR severity in older patients with diabetes may be associated with deterioration of renal function and high prevalence of advanced CKD. Therefore, periodic examination for DR in older patients with diabetes is important for predicting renal function deterioration and CKD progression.

Keyword

Aged; Chronic renal insufficiency; Diabetes mellitus; Diabetic retinopathy

Figure

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  Fig. 1. Distribution of patients included in this study. DM, diabetes mellitus; CKD, chronic kidney disease; ADPKD, autosomal dominant polycystic kidney disease; DR, diabetic retinopathy; NPDR, nonproliferative DR; PDR, proliferative DR.

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  Fig. 2. Comparison of renal function according to the degree of DR in older patients with type 2 diabetes mellitus. As the degree of DR progresses, the mean Cr level increases and the mean eGFR tends to decrease. However, in the post-hoc analysis, there is a significant difference only between the no DR and NPDR groups and between the no DR and PDR groups. Meanwhile, in the Spearman correlation analysis, Cr level and eGFR show positive and negative correlations with the degree of DR, respectively. (A) Comparison of Cr according to the degree of DR. (B) Comparison of eGFR according to the degree of DR. Cr, creatinine; eGFR, estimated glomerular filtration rate; DR, diabetic retinopathy; NPDR, nonproliferative DR; PDR, proliferative DR.

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  Fig. 3. ROC curves of renal function for NPDR and PDR in older patients with type 2 diabetes mellitus (DM). The degree of renal function deterioration in older patients with type 2 DM may be helpful in predicting the presence of NPDR or PDR. (A) ROC curve of Cr level for NPDR. (B) ROC curve of eGFR for NPDR. (C) ROC curve of Cr level for PDR. (D) ROC curve of eGFR for PDR. AUC, area under the curve; CI, confidence interval; ROC, receiver operating characteristic; Cr, creatinine; eGFR, estimated glomerular filtration rate; NPDR, nonproliferative diabetic retinopathy; PDR, proliferative diabetic retinopathy.

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  Fig. 4. Comparison of advanced CKD proportion according to the degree of DR among older patients with type 2 diabetes mellitus (DM) and CKD stage ≥3. The proportion of advanced CKD cases among older patients with type 2 DM and CKD stage >3 increases significantly with the severity of DR. DR, diabetic retinopathy; NPDR, nonproliferative DR; PDR, proliferative DR; CKD, chronic kidney disease.

Reference

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