Diabetic Retinopathy in Patients with Diabetic Nephropathy: Development and Progression.

Chi-Juei Jeng,I-Jong Wang,Chung-May Yang,Cheng-Li Lin,Yi-Ting Hsieh,Chang-Hao Yang,Radouil Tzekov

doi:10.1371/journal.pone.0161897

Abstract

The purpose of current study aims to investigate the development and progression of diabetic retinopathy (DR) in patients with diabetic nephropathy (DN) in a nationwide population-based cohort in Taiwan. Newly diagnosed DN patients and age- and sex-matched controls were identified from the Taiwanese Longitudinal Health Insurance Database from 2000 to 2010. We studied the effects of age, sex, hypertension, dyslipidemia, diabetic polyneuropathy (DPN), and medications on the development of nonproliferative DR (NPDR), proliferative DR (PDR), and diabetic macular edema (DME) in patients with DN. Cox proportional hazard regression analyses were used to estimate the adjusted hazard ratios (HRs) of the development of DR. Our results show that the adjusted HRs of NPDR and PDR were 5.01 (95% confidence interval (CI) = 4.68–5.37) and 9.7 (95% CI = 8.15–11.5), respectively, in patients with DN as compared with patients in the non-DN cohort. At 5-year follow-up, patients with DN showed an increased HR of NPDR progression to PDR (HR = 2.26, 95% CI = 1.68–3.03), and the major comorbidities were hypertension (HR = 1.23, 95% CI = 1.10–1.38 with NPDR; HR = 1.33, 95% CI = 1.02–1.72 with PDR) and DPN (HR = 2.03, 95% CI = 1.72–2.41 in NPDR; HR = 2.95, 95% CI = 2.16–4.03 in PDR). Dyslipidemia increased the HR of developing NPDR but not PDR or DME. Moreover, DN did not significantly affect DME development (HR = 1.47, 95% CI = 0.87–2.48) or progression (HR = 0.37, 95% CI = 0.11–1.20). We concluded that DN was an independent risk factor for DR development and progression; however, DN did not markedly affect DME development in this study, and the potential association between these disorders requires further investigation.

Highlights

Diabetic retinopathy (DR) is the leading cause of blindness in working-age people [1]
In relation to the risk factors identified for DR, epidemiological studies conducted on both type 1 and type 2 diabetes mellitus (DM) patients from the Diabetes Control and Complications Trial (DCCT) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study have revealed the importance of glycemic control in delaying or preventing DR development [4,5,6]
DR, Diabetic nephropathy (DN), and diabetic polyneuropathy (DPN) are the most common complications related to small-vessel injuries due to long-term hyperglycemia [33, 34]

Summary

Introduction

Diabetic retinopathy (DR) is the leading cause of blindness in working-age people [1]. Disease duration, elevated blood pressure, lipid profiles, serum levels of advanced glycation end products (AGEs), evidence of early stage atherosclerosis, increased caliber of retinal blood vessels, and several genetic factors (such as those related to enzymes involved in glucose and lipid metabolism) contribute to the development of DR [4]. Diabetic nephropathy (DN), the primary cause of chronic kidney disease, accounts for 40% of all new cases of end-stage renal disease development recorded annually [7]; DN is characterized by persistent albuminuria, progressive decline of glomerular filtration rate, and elevation of blood pressure [8, 9]. As in the case of DR, the major risk factors identified for DN include prolonged duration of diabetes, poor glycemic control, and hypertension [12]. Optimizing blood-sugar control together with tightly controlling blood pressure can reduce the risk of developing both DR and DN because the diseases share the same microvascular changes [16, 17]

Methods

Results

Conclusion