Diabetic retinopathy as a risk factor for chronic kidney disease progression

A multicenter case–control study in Taiwan

Hsin Ting Lin, Cai Mei Zheng, Yun Chun Wu, Yun Hsiang Chang, Jiann Torng Chen, Chang Min Liang, Tian Jong Chang, Jing Quan Zheng, Ming Cheng Tai, Yuh Feng Lin

Research output: Contribution to journalArticle

Abstract

It has rarely been studied whether the presence and severity of diabetic retinopathy (DR) could influence the renal disease progression among all chronic kidney disease (CKD) diabetic patients. This study investigates the characteristics of diabetic patients, with different stages of chronic kidney disease (CKD), according to the occurrence of diabetic retinopathy and determines the influence of retinopathy in the deterioration of renal function. We conduct a multicenter, longitudinal cohort study based on the Epidemiology and Risk Factors Surveillance of the CKD project (2008–2013) and the National Health Insurance Research Database (NHIRD) (2001–2013). A total of 4050 diabetic patients with CKD, 20–85 years of age, from 14 hospitals and the community are included in this study. As compared to CKD patients without DR, CKD patients with DR have a lower baseline estimated glomerular filtration rate (eGFR) (39.17 ± 30.36 mL/min per 1.73 m 2 vs. 54.38 ± 33.67 mL/min per 1.73 m 2 ); poorer glycemic control (higher glycated hemoglobin (HbA1c) 7.85 ± 4.97 vs. 7.29 ± 4.02, p < 0.01); higher proteinuria (urine protein-to-creatinine ratio (UPCR)1.94 ± 2.96 g/dL vs. 0.91 ± 2.11 g/dL, p < 0.01); more anemia (Hb 11.22 ± 2.43 g/dL vs. 12.39 ± 3.85 g/dL, p < 0.01), and more hypoalbuminemia (3.88 ± 0.95 g/dL vs. 4.16 ± 1.74 g/dL, p < 0.01). Later stage (stage 3b–5) CKD patients with DR had significantly higher CKD progression compared with patients without DR (OR (odds ratio) 1.66 (1.36–2.02)). Patients with proliferative DR had significantly higher CKD progression events compared to patients with non-proliferative DR (OR 2.18 (1.71–2.78)). The presence and severity of DR is a risk factor for CKD progression among our Taiwanese CKD patients with diabetes. Prevention and early detection of DR are important and DR should be routinely screened as early as possible among diabetic CKD patients.

Original languageEnglish
Article number509
JournalNutrients
Volume11
Issue number3
DOIs
Publication statusPublished - Mar 1 2019

Fingerprint

diabetic retinopathy
Diabetic Retinopathy
kidney diseases
Taiwan
Chronic Renal Insufficiency
disease course
Multicenter Studies
Disease Progression
risk factors
glycohemoglobin
Kidney
Hypoalbuminemia
health insurance
retinal diseases
glycemic control
Glycosylated Hemoglobin A
glomerular filtration rate
National Health Programs
Diabetic Nephropathies
Glomerular Filtration Rate

Keywords

  • Chronic kidney disease (CKD) cohort
  • Diabetic retinopathy (DR)
  • Estimated glomerular filtration rate
  • National Health Insurance Research Database
  • Progression of CKD

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics

Cite this

Diabetic retinopathy as a risk factor for chronic kidney disease progression : A multicenter case–control study in Taiwan. / Lin, Hsin Ting; Zheng, Cai Mei; Wu, Yun Chun; Chang, Yun Hsiang; Chen, Jiann Torng; Liang, Chang Min; Chang, Tian Jong; Zheng, Jing Quan; Tai, Ming Cheng; Lin, Yuh Feng.

In: Nutrients, Vol. 11, No. 3, 509, 01.03.2019.

Research output: Contribution to journalArticle

Lin, Hsin Ting ; Zheng, Cai Mei ; Wu, Yun Chun ; Chang, Yun Hsiang ; Chen, Jiann Torng ; Liang, Chang Min ; Chang, Tian Jong ; Zheng, Jing Quan ; Tai, Ming Cheng ; Lin, Yuh Feng. / Diabetic retinopathy as a risk factor for chronic kidney disease progression : A multicenter case–control study in Taiwan. In: Nutrients. 2019 ; Vol. 11, No. 3.
@article{da8dfab1c5174f618b9fe1e796c0983c,
title = "Diabetic retinopathy as a risk factor for chronic kidney disease progression: A multicenter case–control study in Taiwan",
abstract = "It has rarely been studied whether the presence and severity of diabetic retinopathy (DR) could influence the renal disease progression among all chronic kidney disease (CKD) diabetic patients. This study investigates the characteristics of diabetic patients, with different stages of chronic kidney disease (CKD), according to the occurrence of diabetic retinopathy and determines the influence of retinopathy in the deterioration of renal function. We conduct a multicenter, longitudinal cohort study based on the Epidemiology and Risk Factors Surveillance of the CKD project (2008–2013) and the National Health Insurance Research Database (NHIRD) (2001–2013). A total of 4050 diabetic patients with CKD, 20–85 years of age, from 14 hospitals and the community are included in this study. As compared to CKD patients without DR, CKD patients with DR have a lower baseline estimated glomerular filtration rate (eGFR) (39.17 ± 30.36 mL/min per 1.73 m 2 vs. 54.38 ± 33.67 mL/min per 1.73 m 2 ); poorer glycemic control (higher glycated hemoglobin (HbA1c) 7.85 ± 4.97 vs. 7.29 ± 4.02, p < 0.01); higher proteinuria (urine protein-to-creatinine ratio (UPCR)1.94 ± 2.96 g/dL vs. 0.91 ± 2.11 g/dL, p < 0.01); more anemia (Hb 11.22 ± 2.43 g/dL vs. 12.39 ± 3.85 g/dL, p < 0.01), and more hypoalbuminemia (3.88 ± 0.95 g/dL vs. 4.16 ± 1.74 g/dL, p < 0.01). Later stage (stage 3b–5) CKD patients with DR had significantly higher CKD progression compared with patients without DR (OR (odds ratio) 1.66 (1.36–2.02)). Patients with proliferative DR had significantly higher CKD progression events compared to patients with non-proliferative DR (OR 2.18 (1.71–2.78)). The presence and severity of DR is a risk factor for CKD progression among our Taiwanese CKD patients with diabetes. Prevention and early detection of DR are important and DR should be routinely screened as early as possible among diabetic CKD patients.",
keywords = "Chronic kidney disease (CKD) cohort, Diabetic retinopathy (DR), Estimated glomerular filtration rate, National Health Insurance Research Database, Progression of CKD",
author = "Lin, {Hsin Ting} and Zheng, {Cai Mei} and Wu, {Yun Chun} and Chang, {Yun Hsiang} and Chen, {Jiann Torng} and Liang, {Chang Min} and Chang, {Tian Jong} and Zheng, {Jing Quan} and Tai, {Ming Cheng} and Lin, {Yuh Feng}",
year = "2019",
month = "3",
day = "1",
doi = "10.3390/nu11030509",
language = "English",
volume = "11",
journal = "Nutrients",
issn = "2072-6643",
publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",
number = "3",

}

TY - JOUR

T1 - Diabetic retinopathy as a risk factor for chronic kidney disease progression

T2 - A multicenter case–control study in Taiwan

AU - Lin, Hsin Ting

AU - Zheng, Cai Mei

AU - Wu, Yun Chun

AU - Chang, Yun Hsiang

AU - Chen, Jiann Torng

AU - Liang, Chang Min

AU - Chang, Tian Jong

AU - Zheng, Jing Quan

AU - Tai, Ming Cheng

AU - Lin, Yuh Feng

PY - 2019/3/1

Y1 - 2019/3/1

N2 - It has rarely been studied whether the presence and severity of diabetic retinopathy (DR) could influence the renal disease progression among all chronic kidney disease (CKD) diabetic patients. This study investigates the characteristics of diabetic patients, with different stages of chronic kidney disease (CKD), according to the occurrence of diabetic retinopathy and determines the influence of retinopathy in the deterioration of renal function. We conduct a multicenter, longitudinal cohort study based on the Epidemiology and Risk Factors Surveillance of the CKD project (2008–2013) and the National Health Insurance Research Database (NHIRD) (2001–2013). A total of 4050 diabetic patients with CKD, 20–85 years of age, from 14 hospitals and the community are included in this study. As compared to CKD patients without DR, CKD patients with DR have a lower baseline estimated glomerular filtration rate (eGFR) (39.17 ± 30.36 mL/min per 1.73 m 2 vs. 54.38 ± 33.67 mL/min per 1.73 m 2 ); poorer glycemic control (higher glycated hemoglobin (HbA1c) 7.85 ± 4.97 vs. 7.29 ± 4.02, p < 0.01); higher proteinuria (urine protein-to-creatinine ratio (UPCR)1.94 ± 2.96 g/dL vs. 0.91 ± 2.11 g/dL, p < 0.01); more anemia (Hb 11.22 ± 2.43 g/dL vs. 12.39 ± 3.85 g/dL, p < 0.01), and more hypoalbuminemia (3.88 ± 0.95 g/dL vs. 4.16 ± 1.74 g/dL, p < 0.01). Later stage (stage 3b–5) CKD patients with DR had significantly higher CKD progression compared with patients without DR (OR (odds ratio) 1.66 (1.36–2.02)). Patients with proliferative DR had significantly higher CKD progression events compared to patients with non-proliferative DR (OR 2.18 (1.71–2.78)). The presence and severity of DR is a risk factor for CKD progression among our Taiwanese CKD patients with diabetes. Prevention and early detection of DR are important and DR should be routinely screened as early as possible among diabetic CKD patients.

AB - It has rarely been studied whether the presence and severity of diabetic retinopathy (DR) could influence the renal disease progression among all chronic kidney disease (CKD) diabetic patients. This study investigates the characteristics of diabetic patients, with different stages of chronic kidney disease (CKD), according to the occurrence of diabetic retinopathy and determines the influence of retinopathy in the deterioration of renal function. We conduct a multicenter, longitudinal cohort study based on the Epidemiology and Risk Factors Surveillance of the CKD project (2008–2013) and the National Health Insurance Research Database (NHIRD) (2001–2013). A total of 4050 diabetic patients with CKD, 20–85 years of age, from 14 hospitals and the community are included in this study. As compared to CKD patients without DR, CKD patients with DR have a lower baseline estimated glomerular filtration rate (eGFR) (39.17 ± 30.36 mL/min per 1.73 m 2 vs. 54.38 ± 33.67 mL/min per 1.73 m 2 ); poorer glycemic control (higher glycated hemoglobin (HbA1c) 7.85 ± 4.97 vs. 7.29 ± 4.02, p < 0.01); higher proteinuria (urine protein-to-creatinine ratio (UPCR)1.94 ± 2.96 g/dL vs. 0.91 ± 2.11 g/dL, p < 0.01); more anemia (Hb 11.22 ± 2.43 g/dL vs. 12.39 ± 3.85 g/dL, p < 0.01), and more hypoalbuminemia (3.88 ± 0.95 g/dL vs. 4.16 ± 1.74 g/dL, p < 0.01). Later stage (stage 3b–5) CKD patients with DR had significantly higher CKD progression compared with patients without DR (OR (odds ratio) 1.66 (1.36–2.02)). Patients with proliferative DR had significantly higher CKD progression events compared to patients with non-proliferative DR (OR 2.18 (1.71–2.78)). The presence and severity of DR is a risk factor for CKD progression among our Taiwanese CKD patients with diabetes. Prevention and early detection of DR are important and DR should be routinely screened as early as possible among diabetic CKD patients.

KW - Chronic kidney disease (CKD) cohort

KW - Diabetic retinopathy (DR)

KW - Estimated glomerular filtration rate

KW - National Health Insurance Research Database

KW - Progression of CKD

UR - http://www.scopus.com/inward/record.url?scp=85062416160&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062416160&partnerID=8YFLogxK

U2 - 10.3390/nu11030509

DO - 10.3390/nu11030509

M3 - Article

VL - 11

JO - Nutrients

JF - Nutrients

SN - 2072-6643

IS - 3

M1 - 509

ER -