Albuminuria as a biomarker of severity in diabetic retinopathy and in the response to intravitreal treatment in diabetic macular edema.

Abstract

Diabetic macular edema (DME) presents a suboptimal response to antiangiogenic treatment in approximately 30% of patients. We analyzed the relationship between renal function and response to antiangiogenic therapy in patients with DME. A total of 367 patients were collected and distributed into three main groups: uncomplicated diabetic retinopathy (DR) group (n = 97), proliferative diabetic retinopathy (PDR) group (n = 94) and DME group (n = 175). Likewise, patients with DME were divided into two groups: responders to antiangiogenic drugs (n = 96) and non-responders to antiangiogenic drugs (n = 79). Age, type of diabetes, arterial hypertension (AHT), creatinine, HbA1c, albuminuria and glomerular filtration rate were analyzed. In the statistical analysis, chi-square test and t student were used to compare each group. The relationship between albuminuria and response to treatment in the DME group was studied with a binary logistic regression model, estimating odds ratio and their confidence intervals. There are differences between the three main groups in terms of the presence or not of albuminuria. The presence of albuminuria is greater in the group of patients with more severe DR (PDR and DME), compared to the uncomplicated DR group (p < 0.009). In the logistic regression analysis model, a positive relationship was found and the odds ratio for the albuminuria variable and is 2.78 (CI: 1.42-5.36). The presence of albuminuria is associated with a higher degree of DR and worse response to antiangiogenic therapy in patients with DME in our series. Multidisciplinary teams would be necessary to reduce albuminuria and thus optimize the treatment of patients with DME.