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Open AccessArticle

Diabetic Retinopathy as a Risk Factor for Chronic Kidney Disease Progression: A Multicenter Case–Control Study in Taiwan

1
Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
2
Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 114, Taiwan
3
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
4
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
5
Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei 235, Taiwan
6
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan
7
Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei 114, Taiwan
8
Performance Appraisal Section, Secretary Office, Shuang Ho Hospital, Taipei Medical University, Taipei 235, Taiwan
9
Department of Critical Care Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei 235, Taiwan
*
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
Nutrients 2019, 11(3), 509; https://doi.org/10.3390/nu11030509
Received: 31 January 2019 / Revised: 17 February 2019 / Accepted: 24 February 2019 / Published: 27 February 2019
It has rarely been studied whether the presence and severity of diabetic retinopathy (DR) could influence the renal disease progression among all chronic kidney disease (CKD) diabetic patients. This study investigates the characteristics of diabetic patients, with different stages of chronic kidney disease (CKD), according to the occurrence of diabetic retinopathy and determines the influence of retinopathy in the deterioration of renal function. We conduct a multicenter, longitudinal cohort study based on the Epidemiology and Risk Factors Surveillance of the CKD project (2008–2013) and the National Health Insurance Research Database (NHIRD) (2001–2013). A total of 4050 diabetic patients with CKD, 20–85 years of age, from 14 hospitals and the community are included in this study. As compared to CKD patients without DR, CKD patients with DR have a lower baseline estimated glomerular filtration rate (eGFR) (39.17 ± 30.36 mL/min per 1.73 m2 vs. 54.38 ± 33.67 mL/min per 1.73 m2 ); poorer glycemic control (higher glycated hemoglobin (HbA1c) 7.85 ± 4.97 vs. 7.29 ± 4.02, p < 0.01); higher proteinuria (urine protein-to-creatinine ratio (UPCR )1.94 ± 2.96 g/dL vs. 0.91 ± 2.11 g/dL, p < 0.01); more anemia (Hb 11.22 ± 2.43 g/dL vs. 12.39 ± 3.85 g/dL, p < 0.01), and more hypoalbuminemia (3.88 ± 0.95 g/dL vs. 4.16 ± 1.74 g/dL, p < 0.01). Later stage (stage 3b–5) CKD patients with DR had significantly higher CKD progression compared with patients without DR (OR (odds ratio) 1.66 (1.36–2.02)). Patients with proliferative DR had significantly higher CKD progression events compared to patients with non-proliferative DR (OR 2.18 (1.71–2.78)). The presence and severity of DR is a risk factor for CKD progression among our Taiwanese CKD patients with diabetes. Prevention and early detection of DR are important and DR should be routinely screened as early as possible among diabetic CKD patients. View Full-Text
Keywords: chronic kidney disease (CKD) cohort; diabetic retinopathy (DR); progression of CKD; estimated glomerular filtration rate; National Health Insurance Research Database chronic kidney disease (CKD) cohort; diabetic retinopathy (DR); progression of CKD; estimated glomerular filtration rate; National Health Insurance Research Database
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MDPI and ACS Style

Lin, H.-T.; Zheng, C.-M.; Wu, Y.-C.; Chang, Y.-H.; Chen, J.-T.; Liang, C.-M.; Chang, T.-J.; Zheng, J.-Q.; Tai, M.-C.; Lin, Y.-F. Diabetic Retinopathy as a Risk Factor for Chronic Kidney Disease Progression: A Multicenter Case–Control Study in Taiwan. Nutrients 2019, 11, 509. https://doi.org/10.3390/nu11030509

AMA Style

Lin H-T, Zheng C-M, Wu Y-C, Chang Y-H, Chen J-T, Liang C-M, Chang T-J, Zheng J-Q, Tai M-C, Lin Y-F. Diabetic Retinopathy as a Risk Factor for Chronic Kidney Disease Progression: A Multicenter Case–Control Study in Taiwan. Nutrients. 2019; 11(3):509. https://doi.org/10.3390/nu11030509

Chicago/Turabian Style

Lin, Hsin-Ting; Zheng, Cai-Mei; Wu, Yun-Chun; Chang, Yun-Hsiang; Chen, Jiann-Torng; Liang, Chang-Min; Chang, Tian-Jong; Zheng, Jing-Quan; Tai, Ming-Cheng; Lin, Yuh-Feng. 2019. "Diabetic Retinopathy as a Risk Factor for Chronic Kidney Disease Progression: A Multicenter Case–Control Study in Taiwan" Nutrients 11, no. 3: 509. https://doi.org/10.3390/nu11030509

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