Abstract
PurposeTo explore the relationship between chronic kidney disease and diabetic retinopathy in a representative population of Korean diabetic adults.MethodsWe analyzed data from the Korea National Health and Nutrition Examination Surveys (2008-2010). A total of 15,409 individuals (weighted frequency, 32,168,636) aged 19 and over who completed ophthalmologic and renal functional examinations were evaluated. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate of < 60 ml/min/1.73 m2 or proteinuria greater than 1+. Seven standard photographs from the Early Treatment for Diabetic Retinopathy Study were obtained from each eye after pharmacological pupil dilatation. Diabetic retinopathy (DR) was defined as the presence of 1 or more retinal microaneurysms or retinal blot hemorrhages with or without more severe lesions. Vision-threatening diabetic retinopathy (VTDR) was defined as the presence of a clinically significant macular edema (CSME) or proliferative diabetic retinopathy.ResultsCKD was significantly associated with DR and VTDR (odds ratio (OR), 95% confidence interval (CI); 2.49(1.43-4.35) and 3.74(1.56-8.95), respectively) in the diabetic population. After controlling for confounders, however, CKD was significantly associated only with DR [adjusted OR (aOR), 95% CI; 2.34(1.04-5.28)]. In the subgroup analysis for CKD, only proteinuria was significantly associated with DR and VTDR (aOR, 95% CI; 4.56(1.51-13.77) and 5.61(1.06-29.87), respectively) in this population.ConclusionsOur results show that CKD appears to be associated with DR and VTDR in a Korean diabetic population. In particular, proteinuria, not decreased eGFR, is more significantly associated with DR or VTDR.
Highlights
Diabetes mellitus (DM) is one of the most important and common chronic diseases worldwide and is expected to increase in prevalence due to population growth, ageing, and escalating rates of obesity [1,2]
Chronic kidney disease (CKD) was significantly associated with Diabetic retinopathy (DR) and Vision-threatening diabetic retinopathy (VTDR) (odds ratio (OR), 95% confidence interval (CI); 2.49(1.43-4.35) and 3.74(1.56-8.95), respectively) in the diabetic population
In the subgroup analysis for CKD, only proteinuria was significantly associated with DR and VTDR (aOR, 95% CI; 4.56(1.51-13.77) and 5.61(1.06-29.87), respectively) in this population
Summary
Diabetes mellitus (DM) is one of the most important and common chronic diseases worldwide and is expected to increase in prevalence due to population growth, ageing, and escalating rates of obesity [1,2]. DR and CKD are closely associated with age and metabolic and cardiovascular risk factors, such as hypertension, DM, obesity and hyperlipidemia [5, 9,10,11,12,13]. Retinal microvascular signs, such as retinopathy and venular dilatation, have been shown to be predictive of CKD development, and patients with CKD may be at higher risk for many eye diseases including DR [14,15]. Recent few reports have suggested that CKD is associated with DR, this relationship has not been properly investigated in Asian diabetic patients
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