The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes
Background Up to 50–60% of patients with diabetes have non-diabetic kidney disease (NDKD) on kidney biopsy. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the kidney out...
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| Veröffentlicht in: | Clinical kidney journal 2023-10, Vol.16 (10), p.1656-1663 |
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| creator | Bermejo, Sheila González, Ester López-Revuelta, Katia Ibernon, Meritxell López, Diana Martín-Gómez, Adoración Garcia-Osuna, Rosa Linares, Tania Díaz, Montserrat Martín, Nàdia Barros, Xoana Marco, Helena Navarro, Maruja Isabel Esparza, Noemí Elias, Sandra Coloma, Ana Robles, Nicolás Roberto Agraz, Irene Poch, Esteban Rodas, Lida Lozano, Víctor Fernández-Fernández, Beatriz Hernández, Eduardo Martínez, Maria Isabel Stanescu, Ramona Ionela Moirón, José Pelayo García-Fernández, Núria Goicoechea, Marian Calero, Francesca Bonet, Josep Liaño, Fernando Pascual, Julio Bestard, Oriol Praga, Manuel Fulladosa, Xavier Soler, María José |
| description | Background
Up to 50–60% of patients with diabetes have non-diabetic kidney disease (NDKD) on kidney biopsy. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the kidney outcomes and survival in patients with biopsy diagnoses of DN and NDKD according to the presence of DR.
Methods
We conducted an observational, multicentre and retrospective study of the pathological findings of renal biopsies from 832 consecutive patients with diabetes from 2002 to 2014 from 18 nephrology departments. The association of DR with kidney replacement therapy (KRT) or survival was assessed by Kaplan–Meier and Cox regression analyses.
Results
Of 832 patients with diabetes and renal biopsy, 768 had a retinal examination and 221/768 (22.6%) had DR. During a follow-up of 10 years, 288/760 (37.9%) patients with follow-up data needed KRT and 157/760 (20.7%) died. The incidence of KRT was higher among patients with DN (alone or with NDKD) and DR [103/175 (58.9%)] than among patients without DR [88/216 (40.7%), P |
| doi_str_mv | 10.1093/ckj/sfad142 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10539224</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/ckj/sfad142</oup_id><sourcerecordid>2871654969</sourcerecordid><originalsourceid>FETCH-LOGICAL-c348t-fdca8d9f0b4b1c65505dc7bbadc2e6e1bc0cbcf4e0127ca64e0304b00edece283</originalsourceid><addsrcrecordid>eNp9kU1LAzEQhhdRsNSe_AM5iSC1yW52u3sSKX5BwUs9h2Qy66YfmzXJWvvvjbRUvDiHmYH34Z2BN0kuGb1ltMomsFpOfC014-lJMkgpL8dlzrLT407z82Tk_ZLGigrl-SAxiwYJWPwyPmALSGxNtJEKgwHiYm9tJ0OzI7LVv0KLXeMOgvFEem_ByICabE1oyNY6j2RldIs7YvsAdoP-Ijmr5drj6DCHydvjw2L2PJ6_Pr3M7udjyHgZxrUGWeqqpoorBkUev9YwVUpqSLFApoCCgpojZekUZBGXjHJFKWoETMtsmNztfbtebVADtsHJteic2Ui3E1Ya8VdpTSPe7adgNM-qNOXR4frg4OxHjz6IjfGA67Vs0fZepOWUFTmviiqiN3sUnPXeYX28w6j4SUXEVMQhlUhf7Wnbd_-C3_r5kyM</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2871654969</pqid></control><display><type>article</type><title>The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes</title><source>Oxford Journals Open Access Collection</source><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Bermejo, Sheila ; González, Ester ; López-Revuelta, Katia ; Ibernon, Meritxell ; López, Diana ; Martín-Gómez, Adoración ; Garcia-Osuna, Rosa ; Linares, Tania ; Díaz, Montserrat ; Martín, Nàdia ; Barros, Xoana ; Marco, Helena ; Navarro, Maruja Isabel ; Esparza, Noemí ; Elias, Sandra ; Coloma, Ana ; Robles, Nicolás Roberto ; Agraz, Irene ; Poch, Esteban ; Rodas, Lida ; Lozano, Víctor ; Fernández-Fernández, Beatriz ; Hernández, Eduardo ; Martínez, Maria Isabel ; Stanescu, Ramona Ionela ; Moirón, José Pelayo ; García-Fernández, Núria ; Goicoechea, Marian ; Calero, Francesca ; Bonet, Josep ; Liaño, Fernando ; Pascual, Julio ; Bestard, Oriol ; Praga, Manuel ; Fulladosa, Xavier ; Soler, María José</creator><creatorcontrib>Bermejo, Sheila ; González, Ester ; López-Revuelta, Katia ; Ibernon, Meritxell ; López, Diana ; Martín-Gómez, Adoración ; Garcia-Osuna, Rosa ; Linares, Tania ; Díaz, Montserrat ; Martín, Nàdia ; Barros, Xoana ; Marco, Helena ; Navarro, Maruja Isabel ; Esparza, Noemí ; Elias, Sandra ; Coloma, Ana ; Robles, Nicolás Roberto ; Agraz, Irene ; Poch, Esteban ; Rodas, Lida ; Lozano, Víctor ; Fernández-Fernández, Beatriz ; Hernández, Eduardo ; Martínez, Maria Isabel ; Stanescu, Ramona Ionela ; Moirón, José Pelayo ; García-Fernández, Núria ; Goicoechea, Marian ; Calero, Francesca ; Bonet, Josep ; Liaño, Fernando ; Pascual, Julio ; Bestard, Oriol ; Praga, Manuel ; Fulladosa, Xavier ; Soler, María José</creatorcontrib><description>Background
Up to 50–60% of patients with diabetes have non-diabetic kidney disease (NDKD) on kidney biopsy. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the kidney outcomes and survival in patients with biopsy diagnoses of DN and NDKD according to the presence of DR.
Methods
We conducted an observational, multicentre and retrospective study of the pathological findings of renal biopsies from 832 consecutive patients with diabetes from 2002 to 2014 from 18 nephrology departments. The association of DR with kidney replacement therapy (KRT) or survival was assessed by Kaplan–Meier and Cox regression analyses.
Results
Of 832 patients with diabetes and renal biopsy, 768 had a retinal examination and 221/768 (22.6%) had DR. During a follow-up of 10 years, 288/760 (37.9%) patients with follow-up data needed KRT and 157/760 (20.7%) died. The incidence of KRT was higher among patients with DN (alone or with NDKD) and DR [103/175 (58.9%)] than among patients without DR [88/216 (40.7%), P < .0001]. The incidence of KRT was also higher among patients with only NDKD and DR than among those without DR [18/46 (39.1%) versus 79/331 (23.9%), P < .0001]. In multivariate analysis, DR or DN were independent risk factors for KRT {hazard ratio [HR] 2.48 [confidence interval (CI) 1.85–3.31], P < .001}. DN (with or without DR) was also identified as an independent risk factor for mortality [HR 1.81 (CI 1.26–2.62), P = .001].
Conclusions
DR is associated with a higher risk of progression to kidney failure in patients with histological DN and in patients with NDKD.
Lay Summary
Renal biopsies in patients with diabetes are increasing and up to 50–60% of patients with diabetes have non-diabetic kidney disease (NDKD). Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the renal prognosis and survival in patients with DN with or without DR. We demonstrated that the diagnosis of diabetic microangiopathy in terms of DR and/or DN is crucial since it confers a worse renal prognosis, indicating patients at risk for progression to end-stage kidney disease.
Graphical Abstract
Graphical Abstract</description><identifier>ISSN: 2048-8505</identifier><identifier>EISSN: 2048-8513</identifier><identifier>DOI: 10.1093/ckj/sfad142</identifier><language>eng</language><publisher>Oxford University Press</publisher><subject>Original</subject><ispartof>Clinical kidney journal, 2023-10, Vol.16 (10), p.1656-1663</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c348t-fdca8d9f0b4b1c65505dc7bbadc2e6e1bc0cbcf4e0127ca64e0304b00edece283</cites><orcidid>0000-0002-3611-4830</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10539224/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10539224/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,1598,27901,27902,53766,53768</link.rule.ids></links><search><creatorcontrib>Bermejo, Sheila</creatorcontrib><creatorcontrib>González, Ester</creatorcontrib><creatorcontrib>López-Revuelta, Katia</creatorcontrib><creatorcontrib>Ibernon, Meritxell</creatorcontrib><creatorcontrib>López, Diana</creatorcontrib><creatorcontrib>Martín-Gómez, Adoración</creatorcontrib><creatorcontrib>Garcia-Osuna, Rosa</creatorcontrib><creatorcontrib>Linares, Tania</creatorcontrib><creatorcontrib>Díaz, Montserrat</creatorcontrib><creatorcontrib>Martín, Nàdia</creatorcontrib><creatorcontrib>Barros, Xoana</creatorcontrib><creatorcontrib>Marco, Helena</creatorcontrib><creatorcontrib>Navarro, Maruja Isabel</creatorcontrib><creatorcontrib>Esparza, Noemí</creatorcontrib><creatorcontrib>Elias, Sandra</creatorcontrib><creatorcontrib>Coloma, Ana</creatorcontrib><creatorcontrib>Robles, Nicolás Roberto</creatorcontrib><creatorcontrib>Agraz, Irene</creatorcontrib><creatorcontrib>Poch, Esteban</creatorcontrib><creatorcontrib>Rodas, Lida</creatorcontrib><creatorcontrib>Lozano, Víctor</creatorcontrib><creatorcontrib>Fernández-Fernández, Beatriz</creatorcontrib><creatorcontrib>Hernández, Eduardo</creatorcontrib><creatorcontrib>Martínez, Maria Isabel</creatorcontrib><creatorcontrib>Stanescu, Ramona Ionela</creatorcontrib><creatorcontrib>Moirón, José Pelayo</creatorcontrib><creatorcontrib>García-Fernández, Núria</creatorcontrib><creatorcontrib>Goicoechea, Marian</creatorcontrib><creatorcontrib>Calero, Francesca</creatorcontrib><creatorcontrib>Bonet, Josep</creatorcontrib><creatorcontrib>Liaño, Fernando</creatorcontrib><creatorcontrib>Pascual, Julio</creatorcontrib><creatorcontrib>Bestard, Oriol</creatorcontrib><creatorcontrib>Praga, Manuel</creatorcontrib><creatorcontrib>Fulladosa, Xavier</creatorcontrib><creatorcontrib>Soler, María José</creatorcontrib><title>The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes</title><title>Clinical kidney journal</title><description>Background
Up to 50–60% of patients with diabetes have non-diabetic kidney disease (NDKD) on kidney biopsy. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the kidney outcomes and survival in patients with biopsy diagnoses of DN and NDKD according to the presence of DR.
Methods
We conducted an observational, multicentre and retrospective study of the pathological findings of renal biopsies from 832 consecutive patients with diabetes from 2002 to 2014 from 18 nephrology departments. The association of DR with kidney replacement therapy (KRT) or survival was assessed by Kaplan–Meier and Cox regression analyses.
Results
Of 832 patients with diabetes and renal biopsy, 768 had a retinal examination and 221/768 (22.6%) had DR. During a follow-up of 10 years, 288/760 (37.9%) patients with follow-up data needed KRT and 157/760 (20.7%) died. The incidence of KRT was higher among patients with DN (alone or with NDKD) and DR [103/175 (58.9%)] than among patients without DR [88/216 (40.7%), P < .0001]. The incidence of KRT was also higher among patients with only NDKD and DR than among those without DR [18/46 (39.1%) versus 79/331 (23.9%), P < .0001]. In multivariate analysis, DR or DN were independent risk factors for KRT {hazard ratio [HR] 2.48 [confidence interval (CI) 1.85–3.31], P < .001}. DN (with or without DR) was also identified as an independent risk factor for mortality [HR 1.81 (CI 1.26–2.62), P = .001].
Conclusions
DR is associated with a higher risk of progression to kidney failure in patients with histological DN and in patients with NDKD.
Lay Summary
Renal biopsies in patients with diabetes are increasing and up to 50–60% of patients with diabetes have non-diabetic kidney disease (NDKD). Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the renal prognosis and survival in patients with DN with or without DR. We demonstrated that the diagnosis of diabetic microangiopathy in terms of DR and/or DN is crucial since it confers a worse renal prognosis, indicating patients at risk for progression to end-stage kidney disease.
Graphical Abstract
Graphical Abstract</description><subject>Original</subject><issn>2048-8505</issn><issn>2048-8513</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><recordid>eNp9kU1LAzEQhhdRsNSe_AM5iSC1yW52u3sSKX5BwUs9h2Qy66YfmzXJWvvvjbRUvDiHmYH34Z2BN0kuGb1ltMomsFpOfC014-lJMkgpL8dlzrLT407z82Tk_ZLGigrl-SAxiwYJWPwyPmALSGxNtJEKgwHiYm9tJ0OzI7LVv0KLXeMOgvFEem_ByICabE1oyNY6j2RldIs7YvsAdoP-Ijmr5drj6DCHydvjw2L2PJ6_Pr3M7udjyHgZxrUGWeqqpoorBkUev9YwVUpqSLFApoCCgpojZekUZBGXjHJFKWoETMtsmNztfbtebVADtsHJteic2Ui3E1Ya8VdpTSPe7adgNM-qNOXR4frg4OxHjz6IjfGA67Vs0fZepOWUFTmviiqiN3sUnPXeYX28w6j4SUXEVMQhlUhf7Wnbd_-C3_r5kyM</recordid><startdate>20231001</startdate><enddate>20231001</enddate><creator>Bermejo, Sheila</creator><creator>González, Ester</creator><creator>López-Revuelta, Katia</creator><creator>Ibernon, Meritxell</creator><creator>López, Diana</creator><creator>Martín-Gómez, Adoración</creator><creator>Garcia-Osuna, Rosa</creator><creator>Linares, Tania</creator><creator>Díaz, Montserrat</creator><creator>Martín, Nàdia</creator><creator>Barros, Xoana</creator><creator>Marco, Helena</creator><creator>Navarro, Maruja Isabel</creator><creator>Esparza, Noemí</creator><creator>Elias, Sandra</creator><creator>Coloma, Ana</creator><creator>Robles, Nicolás Roberto</creator><creator>Agraz, Irene</creator><creator>Poch, Esteban</creator><creator>Rodas, Lida</creator><creator>Lozano, Víctor</creator><creator>Fernández-Fernández, Beatriz</creator><creator>Hernández, Eduardo</creator><creator>Martínez, Maria Isabel</creator><creator>Stanescu, Ramona Ionela</creator><creator>Moirón, José Pelayo</creator><creator>García-Fernández, Núria</creator><creator>Goicoechea, Marian</creator><creator>Calero, Francesca</creator><creator>Bonet, Josep</creator><creator>Liaño, Fernando</creator><creator>Pascual, Julio</creator><creator>Bestard, Oriol</creator><creator>Praga, Manuel</creator><creator>Fulladosa, Xavier</creator><creator>Soler, María José</creator><general>Oxford University Press</general><scope>TOX</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-3611-4830</orcidid></search><sort><creationdate>20231001</creationdate><title>The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes</title><author>Bermejo, Sheila ; González, Ester ; López-Revuelta, Katia ; Ibernon, Meritxell ; López, Diana ; Martín-Gómez, Adoración ; Garcia-Osuna, Rosa ; Linares, Tania ; Díaz, Montserrat ; Martín, Nàdia ; Barros, Xoana ; Marco, Helena ; Navarro, Maruja Isabel ; Esparza, Noemí ; Elias, Sandra ; Coloma, Ana ; Robles, Nicolás Roberto ; Agraz, Irene ; Poch, Esteban ; Rodas, Lida ; Lozano, Víctor ; Fernández-Fernández, Beatriz ; Hernández, Eduardo ; Martínez, Maria Isabel ; Stanescu, Ramona Ionela ; Moirón, José Pelayo ; García-Fernández, Núria ; Goicoechea, Marian ; Calero, Francesca ; Bonet, Josep ; Liaño, Fernando ; Pascual, Julio ; Bestard, Oriol ; Praga, Manuel ; Fulladosa, Xavier ; Soler, María José</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c348t-fdca8d9f0b4b1c65505dc7bbadc2e6e1bc0cbcf4e0127ca64e0304b00edece283</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Original</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bermejo, Sheila</creatorcontrib><creatorcontrib>González, Ester</creatorcontrib><creatorcontrib>López-Revuelta, Katia</creatorcontrib><creatorcontrib>Ibernon, Meritxell</creatorcontrib><creatorcontrib>López, Diana</creatorcontrib><creatorcontrib>Martín-Gómez, Adoración</creatorcontrib><creatorcontrib>Garcia-Osuna, Rosa</creatorcontrib><creatorcontrib>Linares, Tania</creatorcontrib><creatorcontrib>Díaz, Montserrat</creatorcontrib><creatorcontrib>Martín, Nàdia</creatorcontrib><creatorcontrib>Barros, Xoana</creatorcontrib><creatorcontrib>Marco, Helena</creatorcontrib><creatorcontrib>Navarro, Maruja Isabel</creatorcontrib><creatorcontrib>Esparza, Noemí</creatorcontrib><creatorcontrib>Elias, Sandra</creatorcontrib><creatorcontrib>Coloma, Ana</creatorcontrib><creatorcontrib>Robles, Nicolás Roberto</creatorcontrib><creatorcontrib>Agraz, Irene</creatorcontrib><creatorcontrib>Poch, Esteban</creatorcontrib><creatorcontrib>Rodas, Lida</creatorcontrib><creatorcontrib>Lozano, Víctor</creatorcontrib><creatorcontrib>Fernández-Fernández, Beatriz</creatorcontrib><creatorcontrib>Hernández, Eduardo</creatorcontrib><creatorcontrib>Martínez, Maria Isabel</creatorcontrib><creatorcontrib>Stanescu, Ramona Ionela</creatorcontrib><creatorcontrib>Moirón, José Pelayo</creatorcontrib><creatorcontrib>García-Fernández, Núria</creatorcontrib><creatorcontrib>Goicoechea, Marian</creatorcontrib><creatorcontrib>Calero, Francesca</creatorcontrib><creatorcontrib>Bonet, Josep</creatorcontrib><creatorcontrib>Liaño, Fernando</creatorcontrib><creatorcontrib>Pascual, Julio</creatorcontrib><creatorcontrib>Bestard, Oriol</creatorcontrib><creatorcontrib>Praga, Manuel</creatorcontrib><creatorcontrib>Fulladosa, Xavier</creatorcontrib><creatorcontrib>Soler, María José</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical kidney journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bermejo, Sheila</au><au>González, Ester</au><au>López-Revuelta, Katia</au><au>Ibernon, Meritxell</au><au>López, Diana</au><au>Martín-Gómez, Adoración</au><au>Garcia-Osuna, Rosa</au><au>Linares, Tania</au><au>Díaz, Montserrat</au><au>Martín, Nàdia</au><au>Barros, Xoana</au><au>Marco, Helena</au><au>Navarro, Maruja Isabel</au><au>Esparza, Noemí</au><au>Elias, Sandra</au><au>Coloma, Ana</au><au>Robles, Nicolás Roberto</au><au>Agraz, Irene</au><au>Poch, Esteban</au><au>Rodas, Lida</au><au>Lozano, Víctor</au><au>Fernández-Fernández, Beatriz</au><au>Hernández, Eduardo</au><au>Martínez, Maria Isabel</au><au>Stanescu, Ramona Ionela</au><au>Moirón, José Pelayo</au><au>García-Fernández, Núria</au><au>Goicoechea, Marian</au><au>Calero, Francesca</au><au>Bonet, Josep</au><au>Liaño, Fernando</au><au>Pascual, Julio</au><au>Bestard, Oriol</au><au>Praga, Manuel</au><au>Fulladosa, Xavier</au><au>Soler, María José</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes</atitle><jtitle>Clinical kidney journal</jtitle><date>2023-10-01</date><risdate>2023</risdate><volume>16</volume><issue>10</issue><spage>1656</spage><epage>1663</epage><pages>1656-1663</pages><issn>2048-8505</issn><eissn>2048-8513</eissn><abstract>Background
Up to 50–60% of patients with diabetes have non-diabetic kidney disease (NDKD) on kidney biopsy. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the kidney outcomes and survival in patients with biopsy diagnoses of DN and NDKD according to the presence of DR.
Methods
We conducted an observational, multicentre and retrospective study of the pathological findings of renal biopsies from 832 consecutive patients with diabetes from 2002 to 2014 from 18 nephrology departments. The association of DR with kidney replacement therapy (KRT) or survival was assessed by Kaplan–Meier and Cox regression analyses.
Results
Of 832 patients with diabetes and renal biopsy, 768 had a retinal examination and 221/768 (22.6%) had DR. During a follow-up of 10 years, 288/760 (37.9%) patients with follow-up data needed KRT and 157/760 (20.7%) died. The incidence of KRT was higher among patients with DN (alone or with NDKD) and DR [103/175 (58.9%)] than among patients without DR [88/216 (40.7%), P < .0001]. The incidence of KRT was also higher among patients with only NDKD and DR than among those without DR [18/46 (39.1%) versus 79/331 (23.9%), P < .0001]. In multivariate analysis, DR or DN were independent risk factors for KRT {hazard ratio [HR] 2.48 [confidence interval (CI) 1.85–3.31], P < .001}. DN (with or without DR) was also identified as an independent risk factor for mortality [HR 1.81 (CI 1.26–2.62), P = .001].
Conclusions
DR is associated with a higher risk of progression to kidney failure in patients with histological DN and in patients with NDKD.
Lay Summary
Renal biopsies in patients with diabetes are increasing and up to 50–60% of patients with diabetes have non-diabetic kidney disease (NDKD). Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the renal prognosis and survival in patients with DN with or without DR. We demonstrated that the diagnosis of diabetic microangiopathy in terms of DR and/or DN is crucial since it confers a worse renal prognosis, indicating patients at risk for progression to end-stage kidney disease.
Graphical Abstract
Graphical Abstract</abstract><pub>Oxford University Press</pub><doi>10.1093/ckj/sfad142</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-3611-4830</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Original |
| title | The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes |
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