MO897: Diabetic Retinopathy and Risk of Macrovascular Complications in Patients Undergoing Hemodialysis: A National Population-Based Cohort Study

Abstract

Abstract BACKGROUND AND AIMS The association of diabetic retinopathy (DR) with macrovascular complications in patients with end-stage kidney disease undergoing hemodialysis is unclear. METHOD We conducted a nationwide cohort study of 44 514 incident hemodialysis patients who were enrolled in Taiwan's national health insurance research database between 1 January 2010 and 31 December 2014 and had follow-up data until 31 December 2015. Patients with and without DR were matched by propensity score in a 1:1 ratio. The primary outcomes were acute coronary syndrome (ACS), acute ischemic stroke and hospitalizations for peripheral artery disease (PAD). RESULTS Of the 27 286 patients with type 2 diabetes, 10 537 (38.1%) had DR at baseline. We matched 9164 patients without DR (mean age, 63.7 years; 44.0% women) by propensity score to 9164 patients with DR (mean age, 63.5 years; 43.8% women). Over a median follow-up of 2.8 years, 2781 patients (15.2%) experienced ACS. Stroke occurred in 1613 patients (8.8%), and 1938 patients (10.6%) were hospitalized for PAD. In a multivariable Cox model accounting for the competing risk of death, the presence of DR was associated with an increased risk of stroke {subdistribution hazard ratio (sHR) 1.30 [95% confidence interval (95% CI) 1.17–1.44]; P < 0.0001} and PAD (sHR 1.17, 95% CI 1.08–1.29; P = 0.0006) but not ACS (sHR 0.99, 95% CI 0.91–1.07; P = 0.9168). The observations were consistent across patient subgroups. CONCLUSION Our findings support early identification and close monitoring and management of hemodialysis patients with DR to prevent the development of stroke and PAD.