학술논문
The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes
ORIGINAL ARTICLE
ORIGINAL ARTICLE
Document Type
Clinical report
Author
Bermejo, Sheila; Gonzalez, Ester; Lopez-Revuelta, Katia; Ibernon, Meritxell; Lopez, Diana; Martin-Gomez, Adoration; Garcia-Osuna, Rosa; Linares, Tania; Diaz, Montserrat; Martin, Nadia; Barros, Xoana; Marco, Helena; Navarro, Maruja Isabel; Esparza, Noemi; Elias, Sandra; Coloma, Ana; Robles, Nicolas Roberto; Agraz, Irene; Poch, Esteban; Rodas, Lida; Lozano, Victor; Fernandez-Fernandez, Beatriz; Hernandez, Eduardo; Martinez, Maria Isabel; Stanescu, Ramona Ionela; Moiron, Jose Pelayo; Garcia-Fernandez, Nuria; Goicoechea, Marian; Calero, Francesca; Bonet, Josep; Liano, Fernando; Pascual, Julio; Bestard, Oriol; Praga, Manuel; Fulladosa, Xavier; Soler, Maria Jose
Source
Clinical Kidney Journal. October 2023, Vol. 16 Issue 10, p1656, 8 p.
Subject
Language
English
ISSN
2048-8505
Abstract
INTRODUCTION Diabetes mellitus (DM) is one of the most important health problems worldwide. In 2021 there were 537 million people affected by DM and this number is expected to increase [...]
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. 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. Keywords: diabetes mellitus, diabetic kidney disease, diabetic nephropathy, kidney biopsy, type 2 diabetes
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. 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. Keywords: diabetes mellitus, diabetic kidney disease, diabetic nephropathy, kidney biopsy, type 2 diabetes