Journal of Yeungnam Medical Science

영남대 의대 학술지 편집위원회 (Yeungnam University College of Medicine, Yeungnam University Institute Medical Science)
권호 표지
DOI QR코드

DOI QR Code

Association of advanced chronic kidney disease with diabetic retinopathy severity in older patients with diabetes: a retrospective cross-sectional study

  • Geun Woo Lee (Department of Ophthalmology, Daegu Catholic University School of Medicine) ;
  • Chul Ho Lee (Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine) ;
  • Seong Gyu Kim (Division of Nephrology, Department of Internal Medicine, Daegu Catholic University School of Medicine)
  • 투고 : 2022.03.21
  • 심사 : 2022.04.29
  • 발행 : 2023.04.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Despite the recent increasing trend in the prevalence of type 2 diabetes among older individuals, the relationship between diabetic retinopathy (DR) and chronic kidney disease (CKD) in these patients remains unclear. This study investigated the severity of renal dysfunction according to the degree of DR in older patients with type 2 diabetes. Methods: A total of 116 patients with diabetes and CKD stage ≥3 who visited both the nephrology and ophthalmology outpatient departments between July 2021 and January 2022 were screened. There were 53 patients in the no DR group, 20 in the nonproliferative DR (NPDR) group, and 43 in the proliferative DR (PDR) group. Results: DR severity was related to the deterioration of renal function. The proportion of patients with advanced CKD significantly increased with DR severity (p for trend <0.001). In the multivariate regression model adjusted for age of ≥80 years, male sex, poorly controlled diabetes, macroalbuminuria, insulin use, diabetes duration of ≥10 years, cerebrovascular accident, hypertension, hyperlipidemia, and cardiovascular disease history, the odds ratio compared with the no DR group was approximately 4.6 for the NPDR group and approximately 11.8 for the PDR group, which were both statistically significant (p=0.025 and p<0.001, respectively). Conclusion: DR severity in older patients with diabetes may be associated with deterioration of renal function and high prevalence of advanced CKD. Therefore, periodic examination for DR in older patients with diabetes is important for predicting renal function deterioration and CKD progression.

키워드

참고문헌

  1. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol 1984;102:527-32. https://doi.org/10.1001/archopht.1984.01040030405011
  2. Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR, et al. Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney Int 2003;63:225-32. https://doi.org/10.1046/j.1523-1755.2003.00712.x
  3. Wolf G, Muller N, Mandecka A, Muller UA. Association of diabetic retinopathy and renal function in patients with types 1 and 2 diabetes mellitus. Clin Nephrol 2007;68:81-6. https://doi.org/10.5414/CNP68081
  4. Penno G, Solini A, Zoppini G, Orsi E, Zerbini G, Trevisan R, et al. Rate and determinants of association between advanced retinopathy and chronic kidney disease in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian multicenter study. Diabetes Care 2012;35:2317-23. https://doi.org/10.2337/dc12-0628
  5. Khan MA, Hashim MJ, King JK, Govender RD, Mustafa H, Al Kaabi J. Epidemiology of type 2 diabetes: global burden of disease and forecasted trends. J Epidemiol Glob Health 2020;10:107-11. https://doi.org/10.2991/jegh.k.191028.001
  6. Bellary S, Kyrou I, Brown JE, Bailey CJ. Type 2 diabetes mellitus in older adults: clinical considerations and management. Nat Rev Endocrinol 2021;17:534-48. https://doi.org/10.1038/s41574-021-00512-2
  7. Jung CH, Son JW, Kang S, Kim WJ, Kim HS, Kim HS, et al. Diabetes fact sheets in Korea, 2020: an appraisal of current status. Diabetes Metab J 2021;45:1-10. https://doi.org/10.4093/dmj.2020.0254
  8. Lee PG, Halter JB. The pathophysiology of hyperglycemia in older adults: clinical considerations. Diabetes Care 2017;40:444-52. https://doi.org/10.2337/dc16-1732
  9. Grunwald JE, Pistilli M, Ying GS, Daniel E, Maguire M, Xie D, et al. Association between progression of retinopathy and concurrent progression of kidney disease: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study. JAMAOphthalmol 2019;137:767-74. https://doi.org/10.1001/jamaophthalmol.2019.1052
  10. Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel JP, et al. The world report on ageing and health: a policy framework for healthy ageing. Lancet 2016;387:2145-54. https://doi.org/10.1016/S0140-6736(15)00516-4
  11. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604-12. https://doi.org/10.7326/0003-4819-150-9-200905050-00006
  12. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society ofCardiology and the European Society of Hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018;36:1953-2041. https://doi.org/10.1097/HJH.0000000000001940
  13. Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs: an extension of the modified Airlie House classification: ETDRS report number 10. Ophthalmology 1991;98(5 Suppl):786-806. https://doi.org/10.1016/S0161-6420(13)38012-9
  14. Early Treatment Diabetic Retinopathy Study Research Group. Fundus photographic risk factors for progression of diabetic retinopathy: ETDRS report number 12. Ophthalmology 1991;98(5 Suppl):823-33. https://doi.org/10.1016/S0161-6420(13)38014-2
  15. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986;51:1173-82. https://doi.org/10.1037/0022-3514.51.6.1173
  16. Mogensen CE, Christensen CK, Vittinghus E. The stages in diabetic renal disease: with emphasis on the stage of incipient diabetic nephropathy. Diabetes 1983;32(Suppl 2):64-78. https://doi.org/10.2337/diab.32.2.S64
  17. Ibrahim HN, Hostetter TH. Diabetic nephropathy. J Am Soc Nephrol 1997;8:487-93.
  18. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group; Lachin JM, Genuth S, Cleary P, Davis MD, Nathan DM. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N Engl J Med 2000;342:381-9. https://doi.org/10.1056/NEJM200002103420603
  19. Williams ME. Diabetic nephropathy: the proteinuria hypothesis. Am J Nephrol 2005;25:77-94. https://doi.org/10.1159/000084286
  20. Lachin JM, Bebu I, Bergenstal RM, Pop-Busui R, Service FJ, Zinman B, et al. Association of glycemic variability in type 1 diabetes with progression of microvascular outcomes in the diabetes control and complications trial. Diabetes Care 2017;40:777-83. https://doi.org/10.2337/dc16-2426
  21. Palmberg P, Smith M, Waltman S, Krupin T, Singer P, Burgess D, et al. The natural history of retinopathy in insulin-dependent juvenile-onset diabetes. Ophthalmology 1981;88:613-8. https://doi.org/10.1016/S0161-6420(81)34975-6
  22. Romero-Aroca P, Mendez-Marin I, Baget-Bernaldiz M, Fernendez-Ballart J, Santos-Blanco E. Review of the relationship between renal and retinal microangiopathy in diabetes mellitus patients. Curr Diabetes Rev 2010;6:88-101. https://doi.org/10.2174/157339910790909387
  23. Park CW. Diabetic kidney disease: from epidemiology to clinical perspectives. Diabetes Metab J 2014;38:252-60. https://doi.org/10.4093/dmj.2014.38.4.252
  24. Brocco E, Fioretto P, Mauer M, Saller A, Carraro A, Frigato F, et al. Renal structure and function in non-insulin dependent diabetic patients with microalbuminuria. Kidney Int Suppl 1997;63:S40-4.
  25. Schwartz MM, Lewis EJ, Leonard-Martin T, Lewis JB, Batlle D. Renal pathology patterns in type II diabetes mellitus: relationship with retinopathy. The Collaborative Study Group. Nephrol Dial Transplant 1998;13:2547-52.
  26. Mather HM, Chaturvedi N, Kehely AM. Comparison of prevalence and risk factors for microalbuminuria in South Asians and Europeans with type 2 diabetes mellitus. Diabet Med 1998;15:672-7. https://doi.org/10.1002/(SICI)1096-9136(199808)15:8<672::AID-DIA648>3.0.CO;2-3
  27. Wu AY, Kong NC, de Leon FA, Pan CY, Tai TY, Yeung VT, et al. An alarmingly high prevalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study. Diabetologia 2005;48:17-26. https://doi.org/10.1007/s00125-004-1599-9
  28. Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Hosseini Fard H, Ghojazadeh M. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health Promot Perspect 2020;10:98-115. https://doi.org/10.34172/hpp.2020.18
  29. Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, et al. IDF Diabetes Atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract 2018;138:271-81. https://doi.org/10.1016/j.diabres.2018.02.023
  30. Kramer CK, Retnakaran R. Concordance of retinopathy and nephropathy over time in type 1 diabetes: an analysis of data from the Diabetes Control and Complications Trial. Diabet Med 2013;30:1333-41.
  31. Parving HH, Gall MA, Skott P, Jorgensen HE, Lokkegaard H, Jorgensen F, et al. Prevalence and causes of albuminuria in non-insulin-dependent diabetic patients. Kidney Int 1992;41:758-62. https://doi.org/10.1038/ki.1992.118
  32. El-Asrar AM, Al-Rubeaan KA, Al-Amro SA, Moharram OA, Kangave D. Retinopathy as a predictor of other diabetic complications. Int Ophthalmol 2001;24:1-11. https://doi.org/10.1023/A:1014409829614
  33. Jindal A, Garcia-Touza M, Jindal N, Whaley-Connell A, Sowers JR. Diabetic kidney disease and the cardiorenal syndrome: old disease, new perspectives. Endocrinol Metab Clin North Am 2013;42:789-808. https://doi.org/10.1016/j.ecl.2013.06.002
  34. Schmechel H, Heinrich U. Retinopathy and nephropathy in 772 insulin-treated diabetic patients in relation to the type of diabetes. Diabete Metab 1993;19(1 Pt 2):138-42.
  35. Romero Aroca P, Calvino Dominguez O, Del Castillo Dejardin D. Epidemiologic study of diabetic retinopathy in a primary care unit. Arch Soc Esp Oftalmol 2000;75:147-52.
  36. Cankurtaran V, Inanc M, Tekin K, Turgut F. Retinal microcirculation in predicting diabetic nephropathy in type 2 diabetic patients without retinopathy. Ophthalmologica 2020;243:271-9. https://doi.org/10.1159/000504943
  37. da Silva MO, do Carmo Chaves AE, Gobbato GC, Dos Reis MA, Lavinsky F, Schaan BD, et al. Early neurovascular retinal changes detected by swept-source OCT in type 2 diabetes and association with diabetic kidney disease. Int J Retina Vitreous 2021;7:73.
  38. Ale-Chilet A, Bernal-Morales C, Barraso M, Hernandez T, Oliva C, Vinagre I, et al. Optical coherence tomography angiography in type 1 diabetes mellitus-report 2: diabetic kidney disease. J Clin Med 2021;11:197.