Diabetic Retinopathy and Chronic Kidney Disease: Associations and Comorbidities in a Large Diabetic Population: The Tongren Health Care Study

Abstract

Purpose : To investigate associations between diabetic retinopathy (DR) and chronic kidney disease (CKD) in type 2 diabetes patients.

Methods : In the cross-sectional, community-based Tongren Health Care Study, individuals who attended regular health care check-up examinations from January 2014 to December 2019 were consecutively enrolled. Type 2 diabetes was diagnosed based on fasting plasma glucose concentration of ≥7.0 mmol/L or a medical history, after excluding patients with type 1 diabetes and gestational diabetes. DR was assessed using color fundus photograph. CKD was defined by a reduced estimated glomerular filtration rate (eGFR) of <60ml/min/1.73mm² and/or albuminuria.

Results : Out of 62,217 study participants, 5103 (8.2%) had diabetes. Within the diabetic group, the prevalences of DR, reduced eGFR, albuminuria and CKD was 12.8% (95% confidence interval:11.8,13.7), 4.6% (95%CI:4.2,5.1%), 10.1% (95%CI:9.3,10.9%) and 13.3% (95%CI:12.4,14.3%), respectively. DR was present in 21.0% of the individuals with CKD, and CKD was detectable in 20.9% of the DR patients. Reduced eGFR or albuminuria were concurrent with DR in 3.9% and 18.8% of the participants with DR, respectively. The presence of DR and DR severity were significantly associated with the combined occurrence of CKD and albuminuria (P<0.05), but not with reduced eGFR. Factors independently associated (multivariable analysis) with the presence of CKD instead of DR were older age (P<0.001, OR=1.05), a higher body mass index (P<0.001, OR=1.14), a higher serum concentration of triglycerides (P<0.001, OR=1.26), and a lower blood glucose (P<0.001, OR=0.93). Having both diabetes and arterial hypertension was a significant risk factor for the presence of a reduced eGFR as compared with DR (P=0.005, OR=4.47).

Conclusions : Around 1/5 of CKD patients had concurrent DR, and 1/5 of DR patients had concurrent CKD, in this type 2 diabetes population. Those with older age, higher body mass index, combining with hypertension and dyslipidemia had a higher chance of being affected by CKD than by DR, while those with a higher fasting glucose level had a higher chance of being affected by DR than by CKD.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Prevalence of diabetic retinopathy, chronic kidney disease, reduced eGFR, and albuminuria with age in diabetes population