Risk factors for retinopathy in hemodialysis patients with type 2 diabetes mellitus

Michael Müller,Christoph Wanner,Carl-Ludwig Schönfeld,Tanja Grammer,Thomas Kohnen,Vera Krane,Bernd Genser,Christiane Drechsler,Winfried März

doi:10.1038/s41598-020-70998-9

Abstract

There is limited knowledge on the prevalence and risk factors of diabetic retinopathy (DR) in dialysis patients. We have investigated the association between diabetes mellitus and lipid-related biomarkers and retinopathy in hemodialysis patients. We reviewed 1,255 hemodialysis patients with type 2 diabetes mellitus (T2DM) who participated in the German Diabetes and Dialysis Study (4D Study). Associations between categorical clinical, biochemical variables and diabetic retinopathy were examined by logistic regression. On average, patients were 66 ± 8 years of age, 54% were male and the HbA1c was 6.7% ± 1.3%. DR, found in 71% of the patients, was significantly and positively associated with fasting glucose, HbA1c, time on dialysis, age, systolic blood pressure, body mass index and the prevalence of other microvascular diseases (e.g. neuropathy). Unexpectedly, DR was associated with high HDL cholesterol and high apolipoproteins AI and AII. Patients with coronary artery disease were less likely to have DR. DR was not associated with gender, smoking, diastolic blood pressure, VLDL cholesterol, triglycerides, and LDL cholesterol. In summary, the prevalence of DR in patients with type 2 diabetes mellitus requiring hemodialysis is higher than in patients suffering from T2DM, who do not receive hemodialysis. DR was positively related to systolic blood pressure (BP), glucometabolic control, and, paradoxically, HDL cholesterol. This data suggests that glucose and blood pressure control may delay the development of DR in patients with diabetes mellitus on dialysis.

Highlights

Diabetes mellitus (DM) is more common in Western countries
We investigated the prevalence and risk factors of diabetic retinopathy in patients on hemodialysis due to diabetes mellitus-related end-stage renal disease (ESRD) using data from the German Diabetes Dialysis Study (4D Study: Die Deutsche Diabetes Dialyse Studie), which evaluated atorvastatin 20 mg daily compared to placebo in 1,255 patients with Type 2 diabetes mellitus (T2DM) on maintenance hemodialysis[14]
The prevalence rate of diabetic retinopathy (DR) in T2DM-patients not receiving dialysis is reported at 34.6% by Olafsdottir et al.[5] or 64% by Tomic et al.[6] or, respectively

Summary

Introduction

Diabetes mellitus (DM) is more common in Western countries. Type 2 diabetes mellitus (T2DM) is the most common single disease causing end-stage renal disease (ESRD) which results in hemodialysis. Diabetic nephropathy has been reported in approximately 40% of patients who need renal replacement therapy[2]. Patients with T2DM on hemodialysis show a higher prevalence of co-morbidities and poorer outcome in comparison to non-diabetic patients on d ialysis[3]. This is reflected by a five-year survival rate of only 35%4. The prevalence rate of DR in T2DM-patients not receiving dialysis varies within a broad range: it is reported between 34.65 and 64%6. Of the coincidence of DR and nephropathy, e.g. Banerjee et al.[11], lesser amount of information is available with regard to the prevalence of DR in T2DM dialysis p atients[12,13]

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