April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Serum Cystatin C, Markers of Chronic Kidney Disease and Retinopathy in Indians with Diabetes
Author Affiliations & Notes
  • Wong Chee Wai
    Ophthalmology, Singapore National Eye Centre, Singapore, Singapore
    Singapore Eye Research Institute, Singapore, Singapore
  • Tien Y Wong
    Singapore Eye Research Institute, Singapore, Singapore
    Ophthalmology, National University of Singapore, Singapore, Singapore
  • Wee Boon Teo
    Medicine, National University of Singapore, Singapore, Singapore
  • Ecosse L Lamoureux
    Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore
  • Mohammad Kamran Ikram
    Singapore Eye Research Institute, Singapore, Singapore
    Ophthalmology, National University of Singapore, Singapore, Singapore
  • Paul Mitchell
    Ophthalmology and Westmead Millennium Institute, Centre for Vision Research, University of Sydney, Australia, NSW, Australia
  • Jie Jin Wang
    Ophthalmology and Westmead Millennium Institute, Centre for Vision Research, University of Sydney, Australia, NSW, Australia
  • E SHyong Tai
    Medicine, National University of Singapore, Singapore, Singapore
  • Sunil Sethi
    Pathology, National University of Singapore, Singapore, Singapore
  • Charumathi Sabanayagam
    Singapore Eye Research Institute, Singapore, Singapore
    Ophthalmology, National University of Singapore, Singapore, Singapore
  • Footnotes
    Commercial Relationships Wong Wai, None; Tien Wong, None; Wee Boon Teo, None; Ecosse Lamoureux, None; Mohammad Ikram, None; Paul Mitchell, None; Jie Jin Wang, None; E SHyong Tai, None; Sunil Sethi, None; Charumathi Sabanayagam, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 5363. doi:
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      Wong Chee Wai, Tien Y Wong, Wee Boon Teo, Ecosse L Lamoureux, Mohammad Kamran Ikram, Paul Mitchell, Jie Jin Wang, E SHyong Tai, Sunil Sethi, Charumathi Sabanayagam; Serum Cystatin C, Markers of Chronic Kidney Disease and Retinopathy in Indians with Diabetes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5363.

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

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Abstract

Purpose: Chronic kidney disease (CKD) defined by triple markers including serum creatinine, serum cystatin C and microalbuminuria have been shown to improve prediction of renal failure and mortality in recent studies. We examined the association of CKD defined by triple markers with moderate diabetic retinopathy (DR) in a population-based sample of adults.

Methods: We examined 1,119 Indian adults with diabetes, aged 40-80 years who participated in the Singapore Indian Eye Study (2007-2009). CKD was defined as 1) serum creatinine-based estimated glomerular filtration rate (eGFRcr) <60 ml/min/1.73m2 (n=128) 2) serum cystatin C-based eGFR <60 (eGFRcys, n=225), and 3) microalbuminuria (urine albumin to creatinine ratio of ≥30 mg/g, n=54). Moderate retinopathy defined as an ETDRS severity score of level >43, was assessed from digital fundus photographs of both eyes by trained graders. The associations of CKD defined by each of the three markers alone and in combination (triple markers, eGFRcr<60+eGFRcys<60+microalbuminuria, n=22) with moderate DR were examined using logistic regression models adjusted for potential confounding factors including duration of diabetes, smoking, body mass index, systolic blood pressure and fellow markers.

Results: The prevalence of moderate DR among those with CKD defined by creatinine, cystatin C, and microalbuminuria were 26.6%, 20.9%, and 44.4% respectively. In separate models, CKD-eGFRcr, CKD-eGFRcys and microalbuminuria were independently associated with DR (odds ratio [OR] (95% confidence interval [CI]) = 3.81 (2.09-6.95), 4.19 (2.39-7.33) and 3.47 (1.61-7.49). In models including all 3 markers, compared to those without CKD by any marker, those with CKD defined by triple markers was associated with a twenty-fold odds of having moderate DR (OR [95% CI] =19.45 [6.54-57.85]).

Conclusions: CKD defined by a triple marker panel was strongly associated with moderate DR in Indian adults with diabetes. If confirmed by future prospective studies, a triple marker approach may improve risk stratification of DR in persons with CKD.

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