Link between retinopathy and nephropathy caused by complications of diabetes mellitus type 2 (original) (raw)
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Background: Worldwide, type 2 Diabetes Mellitus (DM) is a public health concern and a major cause of morbidity and mortality. In general, most type 2 diabetic patients are managed in primary healthcare centers. Screening for Diabetic Retinopathy (DR) must not be neglected among patients, and studies suggest that DR is a predictive factor for Diabetic Nephropathy (DN). Aim: To evaluate the possible associations between retinopathy and nephropathy in Saudi patients with type 2 DM attending family medical centers. Methodology: A retrospective study included patients with type 2 diabetes reporting for fundus photography at the Retina Clinic at Al-Wazarat center, Prince Sultan Military Medical City (PSMMC) in Riyadh, Saudi Arabia between January 2019, and December 2021. The collected data included age, gender, clinical parameters including duration of current diabetic status, value of HbA1c, stage of DR, presence of macular edema, presence of hypertension (HTN), DM medication, and presence or absence of microalbuminuria or macro albuminuria. Results: The study sample included 364 patients with type 2 DM. The results showed that 50% of the patients had DR, and 37.6% of the patients had DN, that they were aged ≥ 55 years, the duration of DM (5-< 10, 10-< 15, 15-< 20, ≥ 20 years), and HbA1C level (7.9%, 8%-8.9%, 9%-9.9%, ≥ 10%) associated with the significant risk of DR (OR = 1.59, P = 0.042), (OR = 2.60, 10.15, 18.33, and 12.99; P = 0.015, < 0.001, < 0.001, and < 0.001), and (OR = 6.26, 6.41, and 8.23, and P < 0.001), respectively. In addition, DM medication has associated risk factors with DR (OR = 10.90, 10.18, and p < 0.001) for insulin and oral and insulin, respectively. There was a significant association between DR and DN among type 2 diabetes patients (p = 0.002). Macro albuminuria > 300 mg\g and the GFR level at Stage 2 and Stage 3b are associated with a significant risk of DR (OR=6.07, P < 0.001) and (OR = 1.88, 5.40 P = 0.007, 0.004, respectively). Diabetic nephropathy was an associated significant risk factor for DR (OR = 1.99, P = 0.002). Conclusion: Our study extends these results by demonstrating that there is a correlation between DR and DN.
Diabetic retinopathy may predict the renal outcomes of patients with diabetic nephropathy
Renal failure, 2018
The patients with Type 2 diabetes mellitus (T2DM) and diabetic retinopathy (DR) are prone to develop diabetic nephropathy (DN). In this study, we aimed to clarify the relationship between DR and the progression of DN in patients with T2DM. In the cross-section study, 250 patients with T2DM and biopsy-proven DN were divided into two groups: 130 in the DN without DR group (DN group) and 120 in the DN + DR group. Logistic regression analysis was performed to identify risk factors for DR. Of the above 250 patients, 141 were recruited in the cohort study who received follow-up for at least 1 year and the influence of DR on renal outcome was assessed using Cox regression. Renal outcome was defined as the progression to end-stage renal disease (ESRD). In the cross-section study, the severity of glomerular lesions (class IIb + III) and DM history >10 years were significantly associated with the odds of DR when adjusting for baseline proteinuria, hematuria, e-GFR, and interstitial inflamm...
Diabetes Care, 2012
OBJECTIVE To evaluate the rate and determinants of concordance between advanced diabetic retinopathy (DR) and chronic kidney disease (CKD), as assessed by both albuminuria and estimated glomerular filtration rate (eGFR), in the large cohort of the Renal Insufficiency And Cardiovascular Events (RIACE) Italian multicenter study. RESEARCH DESIGN AND METHODS Patients with type 2 diabetes (n = 15,773) visiting consecutively 19 hospital–based diabetes clinics in years 2007 and 2008 were examined. DR was assessed by dilated fundoscopy. CKD was defined based on albuminuria and eGFR. RESULTS CKD was present in 58.64% of subjects with advanced DR, whereas advanced DR was detectable only in 15.28% of individuals with any CKD and correlated with the albuminuric CKD phenotypes more than with the nonalbuminuric phenotype. Age, male sex, diabetes duration, hemoglobin A1c, hypertension, triglycerides, previous cardiovascular disease, and, inversely, HDL-cholesterol correlated independently with the...
Association of Diabetic Retinopathy, Albuminuria and CKD in Patients with Type 2 Diabetes Mellitus
Journal of Medical Science And clinical Research, 2018
Background: Retinopathy and renal involvement are two of the major microvascular complications of diabetes mellitus. Recent reports challenge the traditional view of renal involvement progressing from increased glomerular filtation to progressively increasing levels of albuminuria that culminate in chronic kidney disease, and have found that retinopathy and albuminuria may not always co-exist. This study was undertaken to understand the relationship between retinopathy, albuminuria and chronic kidney disease in patients with type 2 diabetes mellitus. Methods: One hundred patients with type 2 diabetes mellitus attending the diabetic clinic were evaluated for retinopathy and renal parameters that included a 24 urinary albumin excretion, serum creatinine and evidence of chronic kidney disease based on the estimated glomerular filtration rate. Results: 67 patients were found to have retinopathy, out of which 12 (17.9 %) had no evidence of any abnormal renal parameters, 25 (37.3%) had only abnormal albuminuria (microalbuminuria or macralbuminuria), one (1.5 %) had evidence of CKD, and 29 (43.3 %) had both albuminuria and CKD. 16 patients with CKD did not have any evidence of retinopathy. Conclusion: There was a statistically significant association between the presence and severity of retinopathy, and abnormal urinary excretion of albumin. A similar association between retinopathy and CKD was not seen.
Factors associated with diabetic nephropathy in subjects with proliferative retinopathy
International Urology and Nephrology, 2012
Aim The purpose was to compare the phenotype of subjects with type 2 diabetes mellitus having both retinopathy and nephropathy with that of subjects having retinopathy but no nephropathy. Methods We recruited 196 subjects; 85 were normoalbuminuric (controls), whilst cases consisted of patients with micro-(n = 66) or macroalbuminuria (n = 45). Both groups underwent 24-h blood pressure (BP) monitoring and were analysed regarding markers of the metabolic syndrome, inflammation (erythrocyte sedimentation rate [ESR] and high-sensitivity CRP [hsCRP]) and insulin resistance (HOMA-IR). Results Cases had significantly higher white cell count (P = 0.02), ESR (P \ 0.001), platelets (P = 0.02), triglycerides (P = 0.001), uric acid (P \ 0.001), daytime and night-time systolic BP (P = 0.001 & P = 0.001, respectively), diastolic BP (P = 0.007 & P = 0.001), pulse pressure (P = 0.02 & 0.055) and mean arterial pressure (P = 0.001 & P \ 0.001) in univariate analysis. Cases had a lower haemoglobin level (P = 0.01) and estimated glomerular filtration rate (eGFR) (P = 0.002) in comparison with controls. Multivariate analysis showed that night-time diastolic BP (P = 0.002, B = 1.057), platelet count (P = 0.018, B = 1.007) and eGFR (P \ 0.001, B = 0.097) are independent predictors of diabetic nephropathy. Platelet count (P = 0.045, B = 1.006), night-time mean diastolic BP (P = 0.029, B = 1.042) and eGFR (P = 0.001, B = 0.975) were also found to be independent predictors of the occurrence of microalbuminuria. Conclusions By analysing factors associated with diabetic nephropathy rather than microvascular disease in general, this study provides evidence that night-time diastolic BP and a relative increase in platelet count are associated with incipient diabetic nephropathy.
Association between diabetic retinopathy and diabetic nephropathy among type II diabetics
IP innovative publication pvt. ltd, 2019
Aim: Diadetic retinopathy and diabetic nephropathy are two major microvascular complications of DM causing significant morbidity and mortality. The aim is to study prevalence of DR in diabetics with CKD and its association in different stages of CKD. Materials and Methods: Total of 80 diabetic pts were examined. Type 2 Diabetes mellitus was defined as FBS>126mg/dl or RBS of>200mg/dl with symptoms of diabetes. DR graded by ETDRS classification. CKD was defined as eGFR of less than <60ml/min/1.73m2 or the presence of proteinuria for three or more months and/or parenchymal changes on USG. CKD staging was done by eGFR. Macro-albuminuria was assessed by the urine strip (URISCAN) method. Results: Among 80 patients 37 had CKD of these 24 (64.86%) had DR of variable severity. Among 43 pt with out CKD 12 patients (27.9%) had DR. Compared to pts with out CKD pts with CKD had higher prevalence of DR (p<0.0012) but DR did not corresponded with different stages of CKD(p 0.688). There was strong assosition between macroalbuminuria and diabetic retinopathy. Conclusion: DR prevalence was more in nephropathy irrespective of staging of CKD. It warrents regular retinal examination irrespective of stage of CKD especially when associated with protienuria.
Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2020
Objective: To determine the development and progression of diabetic retinopathy in subjects with diabetic nephropathy. Methodology: This retrospective longitudinal follow up study was conducted in outpatient department of Baqai Institute of Diabetology and Endocrinology (BIDE), a tertiary care diabetes unit of Karachi Pakistan, from January 2005 to December 2016. Type 2 diabetic subjects with newly diagnosed diabetic nephropathy (DN) and sex-age matched controls were identified from the electronic database of the institute, Health Management System (HMS). Subjects with type 1 diabetes, gestational diabetes and subjects with diabetic retinopathy (DR) at the baseline of both DN and non-DN group were excluded from the study. Statistical analyses were conducted by using SPSS version 20. Result: Out of 3056 type 2 diabetic subjects, 2389 were with DN and 667 were without DN. The incidence of retinopathy was found to be 21.7 per 1000 person years. The incidence rate ratio (IRR) of 2.57 (1.92 e3.43) showed that retinopathy was significantly higher in subjects with DN as compared to subjects without DN. Kaplan-Meier survival plot confirmed that subjects with DN had a worse diabetic retinopathy-free survival than subjects without DN. Conclusion: Diabetic nephropathy is an independent risk factor for the development and progression of diabetic retinopathy.
Diabetologia, 2004
Aims/hypothesis. In a previous study conducted over the last decades we found a decreased incidence of nephropathy but unchanged incidence of severe retinopathy among patients with Type 1 diabetes diagnosed in childhood and with 20 years duration of diabetes. The aim of our current study was to investigate the incidence 5 to10 years later in the same population. Methods. We studied all 269 patients in whom Type 1 diabetes was diagnosed in childhood between 1961 and 1985 in a district in southeastern Sweden. Ninetyone percent were monitored for retinopathy until at least 1997 and 95% were monitored for nephropathy. Severe retinopathy was defined as laser-treated retinopathy and nephropathy as persistent proteinuria. Survival analysis was used and the patients divided into five cohorts according to the time of onset of diabetes. Results. The cumulative proportion of severe retinopathy had declined (p=0.006). After 25 years it was 47% (95% CI 34-61), 28% (15-40) and 24% (12-36) in the cohorts 1961 to 1965, 1966 to 1970 and 1971 to 1975 respectively. After 30 years it was 53% (40-66) and 44% (28-59) in the oldest cohorts. The cumulative proportion of nephropathy after 25 years duration was 30% (18-42), 8% (1-16) and 13% (4-23
Biomedical and Pharmacology Journal
Background The relationship between diabetic retinopathy (DR) and nephropathy in type 1 diabetes mellitus (T1DM) is controversial. This study assessed the utility of the spot urinary albumin creatinine ratio (UACR) as a parameter for correlating diabetic nephropathy with DR in individuals with T1DM in Basrah. Methods The study was a cross-sectional observational study of 216 patients with T1DM (16–49 years old) with different DR types. We used demographic variables, different T1DM-related variables (onset and duration of T1DM, glycemic control, latency between T1DM and DR onset, age of onset of DR), and biochemical investigations, such as spot UACR, renal function tests, glycated hemoglobin (HbA1c), anti-glutamic acid decarboxylase-65 (anti-GAD-65) antibody, lipid profile, and thyrotropin. We used ordinal regression analysis to test for the possible primary covariates and adjusted the findings with an analysis of covariates (ANCOVA). Results The patient population showed a slight ma...