Diabetic retinopathy (DR), a window for prediction of potential stage of diabetic kidney disease (DKD) and its progression: An analysis of real-world data

Abstract

Purpose : To substantiate clinical correlation between stages of DR and DKD and establish risk factors impacting the association in real world patient data.

Methods : Data was collected from 366 patients of Kasturba Medical College, India. Fundus images from FF450^Plus (ZEISS, Jena, Germany) along with DR stage annotations, done by the ophthalmologist, from VISUHEALTH platform (ZEISS, Jena, Germany) and nephrology parameters were collected. The inclusion criteria were patients with history of diabetes, DR and DKD, availability of fundus image data and nephrology parameters such as urine protein, serum creatinine and estimated glomerular filtration rate (eGFR). The association between stages of DR and DKD at the baseline visit of patients was analyzed using the chi-square test. A multivariate logistic regression model was used to assess if gender, age, presence of urine protein and DR stage were significant predictors of DKD stage. Follow up data were used to analyze if DR and DKD progress in a similar fashion.

Results : Association was analyzed by clubbing the stages of DKD into Early DKD Stage (Stage 1, 2, 3A and 3B) and Advanced DKD Stage (4 and 5) in Table 1. Odds ratio (OR) evaluated in logistic regression model indicated that age (OR 1.03, p-value 0.003), history of hypertension (OR 7.28, p-value <0.001), duration of hypertension (OR 1.1, p-value < 0.001), HbA1C (OR 0.79, p-value <0.001) and presence of urine protein (OR 19.67, p-value <0.001) are significant risk factors towards DKD stage prediction. The p-value of 0.023 is indicative that the severity of DR and DKD progress in a similar fashion (Table 2).

Conclusions : We observed a significant association between DR stage and clubbed DKD stages, as well as significant association between DR and DKD progression. Such an association in real world data can assist the ophthalmologists in timely referral of long-standing diabetic patients to the nephrologists before the patients progress to end-stage renal disease (ESRD) and eventually renal replacement therapy. Association between DR severity and DKD progression can facilitate an early detection of DKD stage through non-invasive procedures like fundus imaging and urine dipstick test, leading to better management of renal diseases by clinicians and hence an efficient allocation of medical resources.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.