June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Chronic Kidney Disease and Diabetic Retinopathy in an Asian population
Author Affiliations & Notes
  • Charumathi Sabanayagam
    Singapore Eye Research Institute, Singapore, Singapore
    Duke-NUS Graduate Medical School, Singapore, Singapore
  • Mohammad Ikram
    Singapore Eye Research Institute, Singapore, Singapore
    Ophthalmology, National University of Singapore, Singapore, Singapore
  • Huang Huiqi
    Singapore Eye Research Institute, Singapore, Singapore
  • Paul Mitchell
    Department of Ophthalmology, Centre for Vision Research, University of Sydney, Australia, NSW, Australia
    Westmead Millennium Institute, Australia, NSW, Australia
  • Jie Wang
    Department of Ophthalmology, Centre for Vision Research, University of Sydney, Australia, NSW, Australia
    Westmead Millennium Institute, Australia, NSW, Australia
  • Su Chi Lim
    Khoo Teck Puat Hospital, Singapore, Singapore
  • Ecosse Lamoureux
    Singapore Eye Research Institute, Singapore, Singapore
    Department of Ophthalmology, Centre for Eye Research Australia, University of Melbourne, Australia, VIC, Australia
  • E Shyong Tai
    Department of Medicine, National University of Singapore, Singapore, Singapore
    Duke-NUS Graduate Medical School, Singapore, Singapore
  • Tien Wong
    Singapore Eye Research Institute, Singapore, Singapore
    Ophthalmology, National University of Singapore, Singapore, Singapore
  • Footnotes
    Commercial Relationships Charumathi Sabanayagam, None; Mohammad Ikram, None; Huang Huiqi, None; Paul Mitchell, Novartis (R), Bayer (R); Jie Wang, None; Su Chi Lim, None; Ecosse Lamoureux, None; E Shyong Tai, None; Tien Wong, Allergan (C), Bayer (C), Novartis (C), Pfizer (C), GSK (F), Roche (F)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 1538. doi:
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      Charumathi Sabanayagam, Mohammad Ikram, Huang Huiqi, Paul Mitchell, Jie Wang, Su Chi Lim, Ecosse Lamoureux, E Shyong Tai, Tien Wong; Chronic Kidney Disease and Diabetic Retinopathy in an Asian population. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1538.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: Diabetic nephropathy (DN) is commonly associated with diabetic retinopathy (DR). Few studies have demonstrated that chronic kidney disease (CKD) defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 is associated with DR. We hypothesized that the association between CKD and DR would be stronger in the presence of microalbuminuria, an early marker of DN.

Methods: 301 participants with diabetes and of Chinese, Malay and Indian ethnicity aged ≥40 years who participated in the Singapore Prospective Study Program were included. Diabetes was defined according to the recent American Diabetes Association guidelines. Retinal photographs taken from both eyes were graded for DR using the modified Airlie House Classification. Based on the presence of CKD and micro/macroalbuminuria (urinary albumin-to-creatinine ratio ≥30) we defined 4 categories: 1) no CKD and normoalbuminuria (referent) 2) no CKD and micro/macroalbuminuria 3) CKD and normoalbuminuria 4) CKD and micro/macroalbuminuria. We calculated the odds ratios (OR) and 95% confidence interval (CI) of any-DR associated with CKD (n= 54) and micro/macroalbuminuria (n=116) separately and in combination adjusting for potential confounders. We validated our findings, using an independent cohort of Malay adults (n=265) with similar methodology in Singapore.

Results: The prevalence of any-DR was 32.9% in the study population. In separate models, micro/macroalbuminuria was significantly associated with any-DR (OR [95% CI] = 2.27 [1.32-3.91]). However, CKD was not significantly associated with any-DR (1.39 [0.70-2.77]). In the combination model, compared to the referent group, the OR (95% CI) of any-DR were: 2.30 (1.26-4.19) for no CKD and micro/macroalbuminuria, 1.38 (0.49-3.87) for CKD and normoalbuminuria, 2.73 [1.10-6.77] for CKD and micro/macroalbuminuria. Similar findings for any-DR were observed in the replication cohort (3.86 [1.34-9.09] for no CKD and micro/macroalbuminuria, 1.89 (0.56-6.06) for CKD and normoalbuminuria, 4.86 [1.91-12.36] for CKD and micro/macroalbuminuria.

Conclusions: We found that in a multi-ethnic sample of Asian adults, CKD is strongly associated with DR in the presence of micro/macroalbuminuria. Our findings suggest that in the presence of micro/macroalbuminuria, CKD is more likely to be due to DN and therefore more closely associated with DR suggesting a common microvascular pathogenesis.

Keywords: 499 diabetic retinopathy • 498 diabetes • 464 clinical (human) or epidemiologic studies: risk factor assessment  
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