Impaired Creatinine Clearance Is a Significant Risk Factor for Diabetic Retinopathy in Inpatient Non-Insulin Dependent Diabetes

Abstract

Background: The risk factors of diabetic retinopathy in inpatient non-insulin dependent diabetes mellitus (NIDDM) were evaluated, especially for the impaired creatinine clearance. Methods: Those inpatients NIDDM who received ophthalmic consultation were reviewed retrospectively from January, 1995 to April, 1996. Four hundred and seventy-five patients were collected from a chart review. All patients received thorough ophthalmological examinations, including visual acuity, slit lamp biomicros6opy, intraocular pressure, indirect ophthalmoscopy and fluorescein angiography if necessary. Other demographic and laboratory data were recorded for analysis as well, including age, gender, hypertension, previous stroke history, duration of known diabetic history, smoking history, body mass index, and the level of total cholesterol(TC), high-density lipoprotein cholesterol (HDL-C), TC/HDL-C ratio, low-density lipoprotein cholesterol (LDL-C), fasting blood sugar, HbAlc, C-peptide, creatinine. Results: Forty eight percent of 475 patients had diabetic retinopathy, including 59 (12.4%) proliferative type. When creatinine clearance was below 42.4 mI/mm, the risk to develop diabetic retinopathy was increased (odd ratio 3.52, p=O.0001), so did the risk to develop proliferative diabetic retinopathy (odd ratio 8.59, p=0.0002). The risk to develop diabetic retinopathy was also increased with the longer known duration of diabetes (5 toll years, odd ratio 3.44; 11 years or more, odd ratio 10.48). For the patients with previous stroke history, there was a higher risk for developing diabetic retinopathy (odd ratio 3.70, p=0.009). Conclusion: The impaired creatinine clearance is a risk factor for diabetic retinopathy and proliferative diabetic retinopathy in NIDDM in patients on the base of this retrospective study. Other factors, including the known duration of diabetes above 5 years, and old stroke history were also correlated with diabetic retinopathy. The internists should inform the diabetic patient to receive thorough ophtalmologic examination, especially those patients who had impaired creatinine clearance below 42.4 ml/mm.