Meta-analysis

Diabetologia

, Volume 56, Issue 3, pp 457-466

Diabetic retinopathy in predicting diabetic nephropathy in patients with type 2 diabetes and renal disease: a meta-analysis

  • F. HeAffiliated withDepartment of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University
  • , X. XiaAffiliated withDepartment of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University
  • , X. F. WuAffiliated withDepartment of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University
  • , X. Q. YuAffiliated withDepartment of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University
  • , F. X. HuangAffiliated withDepartment of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University Email author 

Abstract

Aims/hypothesis

The aim of this meta-analysis is to determine the predictive value of diabetic retinopathy in differentiating diabetic nephropathy from non-diabetic renal diseases in patients with type 2 diabetes and renal disease.

Methods

Medline and Embase databases were searched from inception to February 2012. Renal biopsy studies of participants with type 2 diabetes were included if they contained data with measurements of diabetic retinopathy. Pooled sensitivity, specificity, positive predictive value, negative predictive value and other diagnostic indices were evaluated using a random-effects model.

Results

The meta-analysis investigated 26 papers with 2012 patients. The pooled sensitivity and specificity of diabetic retinopathy to predict diabetic nephropathy were 0.65 (95% CI 0.62, 0.68) and 0.75 (95% CI 0.73, 0.78), respectively. The pooled positive and negative predictive value of diabetic retinopathy to predict diabetic nephropathy were 0.72 (95% CI 0.68, 0.75) and 0.69 (95% CI 0.67, 0.72), respectively. The area under the summary receiver operating characteristic curve was 0.75, and the diagnostic odds ratio was 5.67 (95% CI 3.45, 9.34). For proliferative diabetic retinopathy, the pooled sensitivity was 0.25 (95% CI 0.16, 0.35), while the specificity was 0.98 (95% CI 0.92, 1.00). There was heterogeneity among studies (p < 0.001), and no publishing bias was identified.

Conclusions/interpretation

Diabetic retinopathy is useful in diagnosing or screening for diabetic nephropathy in patients with type 2 diabetes and renal disease. Proliferative diabetic retinopathy may be a highly specific indicator for diabetic nephropathy.

Keywords

Diabetic nephropathy Diabetic retinopathy Meta-analysis Non-diabetic renal disease Renal biopsy Type 2 diabetes