Is chronic kidney disease associated with diabetic retinopathy in Asian adults?

Charumathi Sabanayagam*, Valencia Hui Xian Foo, M. Kamran Ikram, Huiqi Huang, Su Chi Lim, Ecosse L. Lamoureux, E. Shyong Tai, Tien Yin Wong

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

28 Citations (Scopus)
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Abstract

Background: 

Diabetic nephropathy (DN) is commonly associated with diabetic retinopathy (DR). Few studies have demonstrated that chronic kidney disease (CKD) is associated with DR. However, it is not clear if CKD in the absence of albuminuria is associated with DR. 

Methods: 

We included 301 participants with diabetes (Chinese, Malay and Indian ethnicity aged ≥24 years who participated in the Singapore Prospective Study Program (2003-2007). Retinal photographs taken from both eyes were graded for DR using the modified Airlie House Classification. We examined the association of CKD defined by low estimated glomerular filtration rate (eGFR) (<60mL/min per 1.73m2, n=54), and albuminuria (urinary albumin-to-creatinine ratio ≥30, n = 116) with any-DR (n=99) in logistic regression models. We replicated this analysis in another independent population-based sample of Malay adults (n=265) with similar methodology in Singapore. 

Results: 

41% of those with low-eGFR had normoalbuminuria. In separate models, while albuminuria was significantly associated with any-DR, low-eGFR was not significantly associated with any-DR. In a model combining both markers, compared to the referent group (normal-eGFR+normoalbuminuria), the odds ratio (OR) (95% confidence interval [CI]) of any-DR were: 2.33 (1.27-4.27) for normal-eGFR+albuminuria, 1.38 (0.49-3.91) for low-eGFR + normoalbuminuria, and 2.64 (1.05-6.63) for low-eGFR+albuminuria. Similar findings for any-DR were observed in the replication cohort of Malay persons (3.56 [1.49-8.54] for normal-eGFR+albuminuria, 1.69 (0.52-5.55) for low-eGFR+normoalbuminuria, 4.34 [1.68-11.24] for low-eGFR+albuminuria.

Conclusion: 

We demonstrated that CKD is associated with DR only in the presence of albuminuria suggesting that CKD is more likely related to diabetes in the presence of albuminuria.

Original languageEnglish
Pages (from-to)556-563
Number of pages8
JournalJournal of Diabetes
Volume6
Issue number6
Early online date18 Mar 2014
DOIs
Publication statusPublished - Nov 2014

Bibliographical note

Publisher Copyright:
© 2014 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

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