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Retinopathy and Risk of Kidney Disease in Persons With Diabetes
Jingyao Hong1, Aditya Surapaneni1, Natalie Daya1
1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Insights
Diabetic retinopathy is linked to increased risks of chronic kidney disease (CKD), end-stage kidney disease (ESKD), and coronary heart disease (CHD). This suggests shared underlying mechanisms in diabetes complications.
Area of Science:
- Endocrinology and Metabolism
- Nephrology
- Ophthalmology
- Cardiology
Background:
- Diabetic microvascular complications (retinopathy, chronic kidney disease) and macrovascular complications (cardiovascular disease) may share common pathological pathways.
- Understanding these shared mechanisms is crucial for comprehensive diabetes management.
Purpose of the Study:
- To quantify the association between retinopathy and the risk of kidney disease in individuals with diabetes.
- To compare this association with the risk of cardiovascular disease in the same population.
Main Methods:
- Retrospective cohort study involving 1,759 participants with diabetes from the ARIC study.
- Retinopathy was assessed, and associations with prevalent and incident kidney disease (CKD, ESKD), coronary heart disease (CHD), and stroke were analyzed using logistic and Cox proportional hazards models.
Main Results:
- Participants with retinopathy had a higher prevalence of reduced estimated glomerular filtration rate (eGFR) and albuminuria.
- Retinopathy was associated with increased risk of incident CKD, ESKD, CHD, and stroke.
- A stronger association was observed between retinopathy and CHD compared to retinopathy and CKD.
Conclusions:
- The presence of retinopathy is associated with a higher prevalence and risk of kidney disease and cardiovascular events in individuals with diabetes.
- These findings suggest a potential common pathophysiological mechanism linking retinopathy to other adverse outcomes in diabetes.
- Further research may elucidate these shared pathways for improved patient outcomes.
Rationale & Objective:
Retinopathy and chronic kidney disease (CKD) are typically considered microvascular complications of diabetes, and cardiovascular and cerebrovascular diseases are considered macrovascular complications; however, all may share common pathological mechanisms. This study quantified the association of retinopathy with risk of kidney disease and compared with the association with cardiovascular disease in persons with diabetes.
Study Design:
Retrospective cohort study.
Setting & Participants:
1,759 participants in the ARIC study who had diabetes at visit 4 and underwent retinal examination at visit 3.
Exposure:
Retinopathy.
Outcome:
Prevalent CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2), prevalent albuminuria (urinary albumin-creatinine ratio [UACR] > 30 mg/g), incident CKD, incident end-stage kidney disease (ESKD), incident coronary heart disease (CHD), and incident stroke.
Analytical Approach:
The cross-sectional association of retinopathy with prevalent CKD and albuminuria was assessed by logistic regression. The associations between retinopathy, incident CKD, incident ESKD, incident CHD, and incident stroke were examined using Cox proportional hazards models. Seemingly unrelated regression was used to compare the strength of association between retinopathy and outcomes.
Results:
During the median follow-up period of 14.2 years, 723 participants developed CKD, and there were 109 ESKD events, 399 CHD events, and 196 stroke events. Compared with the participants without retinopathy, participants with retinopathy were more likely to have reduced eGFR (OR, 1.56 [95% CI, 1.09-2.23]) and UACR > 30 mg/g (OR, 1.61 [95% CI, 1.24-2.10]). Retinopathy was associated with risk of incident CKD (HR, 1.22 [95% CI, 1.02-1.46]), ESKD (HR, 1.69 [95% CI, 1.11-2.58]), CHD (HR, 1.46 [95% CI, 1.15-1.84]), and stroke (HR, 1.43 [95% CI, 1.03-1.97]). A stronger relationship was found between retinopathy and CHD when compared with retinopathy and CKD (P = 0.03); all other associations were similar.
Limitations:
Retinal examination and kidney measurements were taken at different visits.
Conclusions:
The presence of retinopathy was associated with higher prevalence of kidney disease and higher risk of incident CKD, ESKD, and CHD. These results may suggest that a similar mechanism underlies the development of retinopathy and other adverse outcomes in diabetes.
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