498-P: Prevalence and Impact on Quality of Life of Diabetic Retinopathy in African Americans with End-Stage Kidney Disease on Hemodialysis

Background: The prevalence, severity, and quality of life (QoL) impact of diabetic retinopathy (DR) among African Americans (AA) with end-stage-kidney disease (ESKD) receiving dialysis are unknown. Methods: We conducted a prospective cross-sectional study in 93 AA adults with type 1 (n=9) and type 2 (n=84) diabetes with ESKD on hemodialysis. The diagnosis of DR was based on a review of medical records and/or having a positive photograph with a portable hand-held device (Optomed Aurora retinal camera) reviewed by both artificial intelligence software (AEYE Health’s retinal screening system) and a retinal specialist. Visual acuity was assessed with the Snellen Chart. Associations with QoL (ascertained using kidney disease QoL and depression questionnaires), physical disability (ascertained using visual impairment questionnaire), and social determinants of health (SDoH) including personal and household income, marital status, health insurance, education, food insecurity, or employment status assessed by standardized questionnaires. Results: The overall prevalence of DR was 75%, with 33% of patients having mild, 9.6% moderate and 57.4% severe DR. A total of 43% had normal visual acuity, 45% had moderate and 12% severe visual impairment. We found high burden of disease, multiple SDoH challenges, and low QoL among all patients, with most unemployed or disabled, living below poverty line, mainly receiving public health insurance, reporting poor general health, and substantial time spent dealing with kidney disease interfered with daily and family activities. However, the presence of DR had no significant impact on physical health and QoL compared to subjects without DR. Conclusion: DR is present in 75% of AA patients with diabetes and ESKD on hemodialysis. ESKD has a significant burden on general health and QoL; however, DR has a minor additional impact on the overall physical health and QoL in people with ESKD and diabetes.