Chronic Kidney Disease Severity and Progression to Proliferative Diabetic Retinopathy

To determine whether chronic kidney disease (CKD) severity is associated with progression from nonproliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) and severe retinal complications.

In this retrospective TriNetX cohort study, adults with Type 2 diabetes and NPDR were matched 1:1 by CKD stage (1-2, 3, 4-5 or end-stage renal disease [ESRD]) to patients without CKD. Patients with prior PDR, diabetic macular oedema, intravitreal treatment, or vitrectomy were excluded. Cox models estimated 3-year hazard ratios (HRs) for PDR and a composite of PDR, vitreous haemorrhage, tractional retinal detachment or vitrectomy. Sensitivity analyses used laboratory-defined estimated glomerular filtration rate and cohorts restricted to mild NPDR or documented baseline haemoglobin A1c.

Matched comparisons included 8476, 24 432, 9933 and 7359 patients with CKD Stages 1-2, 3, 4-5 and ESRD, respectively, with equal-sized reference cohorts. PDR risk increased with CKD severity: HR 1.12 (95% confidence interval [CI] 0.96-1.29) for Stages 1-2, 1.35 (1.23-1.47) for Stage 3, 1.59 (1.40-1.80) for Stages 4-5 and 1.66 (1.45-1.89) for ESRD. Similar associations were observed for the composite and persisted in laboratory-defined and mild-NPDR-restricted analyses, although residual baseline haemoglobin A1c imbalance remained in advanced CKD comparisons.

CKD Stage 3 or higher was associated with greater progression from NPDR to PDR and severe retinal complications. CKD severity may identify higher-risk patients, although prospective studies are needed before CKD-specific surveillance is recommended.