July 2019
Volume 60, Issue 9
Free
ARVO Annual Meeting Abstract  |   July 2019
Association of diagnosis code-based and laboratory results-based kidney disease with development of vision threatening diabetic retinopathy
Author Affiliations & Notes
  • Yinxi Yu
    University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Brian L VanderBeek
    University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Gui-Shuang Ying
    University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Maureen G Maguire
    University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Footnotes
    Commercial Relationships   Yinxi Yu, None; Brian VanderBeek, None; Gui-Shuang Ying, None; Maureen Maguire, None
  • Footnotes
    Support  National Institutes of Health K23 Award (1K23EY025729 - 01) and University of Pennsylvania Core Grant for Vision Research (2P30EY001583). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Additional funding was provided by Research to Prevent Blindness and the Paul and Evanina Mackall Foundation. Funding from each of the above sources was received in the form of block research grants to the Scheie Eye Institute. None of the organizations had any role in the design or conduction of the study.
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 3949. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to authenticated users only.
      Sign In or Create an Account ×
    • Get Citation

      Yinxi Yu, Brian L VanderBeek, Gui-Shuang Ying, Maureen G Maguire; Association of diagnosis code-based and laboratory results-based kidney disease with development of vision threatening diabetic retinopathy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3949.

      Download citation file:


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

      ×
  • Supplements
Abstract

Purpose : Studies have shown in diabetics that decreased renal function is strongly associated with retinopathy. In some administrative medical claims databases, both diagnosis code and laboratory results are available to identify decreased renal function, but no study has evaluated whether there are differences in their associations with retinopathy. In this study, we compared the association of kidney disease (KD) identified through diagnosis code to lab value-based identification of KD with development of vision threatening diabetic retinopathy(VTDR).

Methods : A national administrative medical claims database was used for this retrospective observational study. All individuals age ≥ 18 years with diagnosed nonproliferative diabetic retinopathy(NPDR) were followed longitudinally. ICD9/10 CKD diagnoses from outpatient claims were used to classify KD without or with end stage renal disease(ESRD). Serum creatinine results were used to calculate estimated glomerular filtration rates(eGFR) which were categorized based on the National Kidney Foundation’s levels of disease. VTDR was defined as any new diagnosis of diabetic macular edema or proliferative diabetic retinopathy. Multivariate Cox models were used to assess the associations of KD diagnosis and eGFR(modelled as time-dependent variables) with progression to VTDR, controlling for demographics and time-updating covariates (systemic health, laboratory values, insulin use). Hazard ratio(HR), C-statistic(a measure of model discrimination) and their 95% confidence intervals(CI) were calculated.

Results : Among 69,982 enrollees with NPDR, 12,770(18.2%) developed VTDR during a median of 1.5 years follow-up. In multivariate analysis, lower eGFR was associated with higher risk of VTDR(eGFR 15-29:HR=1.14;95%CI:1.02-1.27,p=0.02; eGFR<15:HR:1.37;95%CI:1.25-1.50,p<0.001) compared to patients with eGFR ≥ 90. Whereas a diagnosis of ESRD was associated with higher risk of VTDR(HR=1.07,95%CI:1.01-1.13,p=0.02), but a diagnosis of KD without ESRD was not (HR=0.97,95%:0.92-1.03,p=0.35) when compared to normals. C-statistic was 0.60(95%CI:0.59-0.60) for the model with eGFR and for the model with KD diagnosis.

Conclusions : Both diagnosis-based and lab value-based KD were associated with development of VTDR. There was no difference in their ability to predict development of VTDR.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×