Abstract
Purpose :
The objective of this study was to examine whether these diabetic retinopathy (DR) and nephropathy (DN) have significant concordance in terms of progression of severity.
Methods :
A cross-sectional, case-control study was performed in two cohorts of type 2 diabetic patients in a New Mexican population: Cases had confirmed end-stage renal disease (ESRD; Stage 5, on dialysis, GFR<15, n=163) and the Controls had mild DN (Stage 1 or Stage 2, GFR>60, n=164). Systemic parameters including HbA1C, blood pressure (BP), lipid levels, serum creatinine (Cr), and retinopathy status by dilated fundus exam were collected by retrospective chart review. Statistical analyses were performed with univariate and multivariate analysis for continuous variables and Chi-squared test for categorical variables.
Results :
The majority (65%) of the ESRD cohort had advanced eye disease (proliferative diabetic retinopathy; PDR), while 18% of patients had no/mild eye disease (No DR/ mild non-proliferative diabetic retinopathy; NPDR). Conversely, the mild DN cohort included a significant number of advanced DR (PDR cases) (38%). In the univariate analysis, the development of ESRD was significantly associated with lower HbA1C levels (p<0.0001) and higher systolic BP levels (p<0.0001). In the ESRD cohort, development of PDR was significantly associated with younger age (p=0.0002), higher diastolic BP (p=0.0319), and higher LDL (p=0.0361). In the multivariate analysis, development of PDR was inversely associated with age (p=.001, OR= 0.95), and positively associated with Cr serum (p<0.0001, OR=1.25), systolic blood pressure (p=0.0221, OR=1.023), and albuminuria (p=0.0006, OR=4.65). The development of PDR was not significantly associated with HbA1C level in either univariate (p=0.6) or multivariate analysis (p=0.3099). The development of CKD using PDR has a sensitivity of 78.68% and a specificity of 51.16%, suggestive of a suboptimal screening tool.
Conclusions :
Our findings suggest that there is discordance between progression of retinopathy and nephropathy. HbA1c levels were not significantly correlative with the progression of PDR, suggesting divergent pathogenesis for development of the two microvascular diseases.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.