Time-sequential correlations between diabetic kidney disease and diabetic retinopathy in type 2 diabetes - an 8-year prospective cohort study.

Abstract

To investigate the time-sequential correlations between progression/remission of diabetic kidney disease (DKD) and development of diabetic retinopathy (DR) or diabetic macular oedema (DME) in type 2 diabetes (T2D). This was an 8-year prospective cohort study in which 576 patients with T2D and microalbuminuria from one medical centre in Taiwan were recruited. Progression of microalbuminuria was defined as shift of urinary albumin/creatinine ratio (ACR) into 300mg/g or more; remission of microalbuminuria was defined as having a urinary ACR less than 30mg/g in at least two of three tests over a period of 6months. Cox regression analysis was used to evaluate the hazard ratios (HRs) for progression or remission of microalbuminuria on development of any DR, proliferative DR (PDR) and DME. After adjusting for baseline characteristics , remission of microalbuminuria was a significant protecting factor for development of PDR (HR=0.290, 95% CI: 0.102-0.826, p=0.020) and DME (HR=0.404, 95% CI: 0.188-0.864, p=0.020). After further adjustment for the mean follow-up HbA1c and systolic blood pressure, remission of microalbuminuria was still a significant protecting factor for development of PDR (HR=0.348, 95% CI: 0.122-0.992, p=0.048). Remission of microalbuminuria was an independent protecting factor for development of PDR and DME. Aggressive treatment for DKD might help prevent the progression of DR.