International Urology and Nephrology

, Volume 46, Issue 7, pp 1375–1381 | Cite as

Diabetic retinopathy and renal function in Chinese type 2 diabetic patients

  • Huiyan Zhang
  • Jianyong Wang
  • Gui-shuang Ying
  • Liping Shen
  • Zhe Zhang
Nephrology - Original Paper

Abstract

Aims

To evaluate associations of diabetic retinopathy (DR) with renal function in Chinese type 2 diabetic patients.

Methods

This cross-sectional study enrolled 523 type 2 diabetic patients. All patients underwent ophthalmic examination to assess DR [normal, non-proliferative DR (NPDR), proliferative DR (PDR)]. The renal function measurements were taken in urine and blood. The estimated glomerular rate (eGFR) and albumin/creatinine ratio (ACR) were calculated using standard formulas. The chronic kidney disease (CKD) was defined as eGFR < 60 mL/min/1.73 m2, and microalbuminuria was defined as ACR > 17 for males and ACR > 25 for females. The associations of DR with renal function and CKD were assessed by regression models, without and with the adjustment of risk factors for CKD.

Results

In multivariate analysis, increasing severity of DR was significantly associated with lower eGFR (p < 0.001), higher level of retinol-binding protein (p < 0.001), and larger ACR (p < 0.0001). The DR was significantly associated increased risk of CKD with odds ratio of 2.22 (95 % CI 1.01–4.86) for NPDR and 3.52 (1.30–9.55) for PDR.

Conclusions

Among Chinese type 2 diabetic patients, increasing DR severity is significantly associated reduced kidney function and increased risk of CKD. These associations are independent of risk factors for CKD, suggesting that assessment of DR may provide useful information on the renal function and risk of kidney disease.

Keywords

Diabetic retinopathy Renal function Chronic kidney disease 

Notes

Acknowledgments

This study was partially supported by Zhejiang Province Technology Application Research Planning Grant 2011C33029 and Zhejiang Provincial Natural Science Foundation of China (Y13B020006).

Conflict of interest

None.

References

  1. 1.
    Yang W, Lu J, Weng J et al (2010) Prevalence of diabetes among men and women in China. N Engl J Med 362:1090–1101PubMedCrossRefGoogle Scholar
  2. 2.
    The Diabetes Control and Complications (DCCT) Research Group (1995) Effect of intensive therapy on the development and progression of diabetic nephropathy in the Diabetes Control and Complications Trial. Kidney Int 47:1703–1720CrossRefGoogle Scholar
  3. 3.
    UK Prospective Diabetes Study (UKPDS) Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352:837–853CrossRefGoogle Scholar
  4. 4.
    Klein R, Klein BE, Moss SE (1996) Relation of glycemic control to diabetic microvascular complications in diabetes mellitus. Ann Intern Med 124:90–96PubMedCrossRefGoogle Scholar
  5. 5.
    Klein R, Klein BE, Moss SE, Cruickshanks KJ, Brazy PC (1999) The 10-year incidence of renal insufficiency in people with type 1 diabetes. Diabetes Care 22:743–751PubMedCrossRefGoogle Scholar
  6. 6.
    The Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986CrossRefGoogle Scholar
  7. 7.
    The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group (2000) Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N Engl J Med 342:381–389PubMedCentralCrossRefGoogle Scholar
  8. 8.
    Yau JW, Xie J, Kawasaki R et al (2011) Retinal arteriolar narrowing and subsequent development of CKD stage 3: the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Kideny Dis 58:39–46CrossRefGoogle Scholar
  9. 9.
    Gall MA, Rossing P, Skøtt P et al (1991) Prevalence of micro- and macroalbuminuria, arterial hypertension, retinopathy and large vessel disease in European type 2 (non-insulin-dependent) diabetic patients. Diabetologia 34:655–661PubMedCrossRefGoogle Scholar
  10. 10.
    Penno G, Solini A, Zoppini G, Orsi E, Zerbini G, Trevisan R, Gruden G, Cavalot F, Laviola L, Morano S, Nicolucci A, Pugliese G, Renal Insufficiency and Cardiovascular Events (RIACE) Study Group (2012) Rate and determinants of association between advanced retinopathy and chronic kidney disease in patients with type 2 diabetes: the renal insufficiency and cardiovascular events (RIACE) Italian multicenter study. Diabetes Care 35:2317–2323PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Zhang HY, Wang JY, Ying GS, Shen LP, Zhang Z (2013) Serum lipids and other risk factors for diabetic retinopathy in Chinese type 2 diabetic patients. J Shejiang Univ Sci B (Biomed Biotechnol) 14:392–399CrossRefGoogle Scholar
  12. 12.
    Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 15:539–553PubMedCrossRefGoogle Scholar
  13. 13.
    National Health and Medical Research Council of Australia (1997) Management of diabetic retinopathy; Clinical Practice Guidelines 1–94Google Scholar
  14. 14.
    Chen BD, Yajng DG, Chen Y et al (2010) The prevalence of microalbuminuria and its relationships with the components of metabolic syndrome in the general population of China. Clin Chim Acta 411:705–709PubMedCrossRefGoogle Scholar
  15. 15.
    Stevens LA, Coresh J, Greene T, Levey AS (2006) Assessing kidney function—measured and estimated glomerular filtration rate. N Engl J Med 354:2473–2483PubMedCrossRefGoogle Scholar
  16. 16.
    National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S266Google Scholar
  17. 17.
    Wong TY, Coresh J, Klein R et al (2004) Retinal microvascular abnormalities and renal dysfunction: the atherosclerosis risk in communities study. J Am Soc Nephrol 15:2469–2476PubMedCrossRefGoogle Scholar
  18. 18.
    Sabanayagam C, Shankar A, Koh D et al (2009) Retinal microvascular caliber and chronic kidney disease in an Asian population. Am J Epidemiol 169:625–632PubMedCrossRefGoogle Scholar
  19. 19.
    Awua-Larbi S, Wong TY, Cotch MF et al (2011) Retinal arteriolar caliber and urine albumin excretion: the Multi-Ethnic Study of Atherosclerosis. Nephrol Dial Transpl 26:3523–3528CrossRefGoogle Scholar
  20. 20.
    Lim LS, Cheung CY, Sabanayagam C et al (2013) Structural changes in retinal microvasculature and renal function. Invest Ophthalmol Vis Sci 54:2970–2976PubMedCrossRefGoogle Scholar
  21. 21.
    Molitch ME, Steffes M, Sun W, Epidemiology of Diabetes Interventions and Complications Study Group et al (2010) Development and progression of renal insufficiency with and without albuminuria in adults with type 1 diabetes in the diabetes control and complications trial and the epidemiology of diabetes interventions and complications study. Diabetes Care 33:1536–1543PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Retnakaran R, Cull CA, Thorne KI, Adler AI, Holman RR, UKPDS Study Group (2006) Risk factors for renal dysfunction in type 2 diabetes: UK prospective diabetes study 74. Diabetes 55:1832–1839PubMedCrossRefGoogle Scholar
  23. 23.
    Pang C, Jia L, Jiang S, Hou X et al (2011) Determination of diabetic retinopathy prevalence and associated risk factors in Chinese diabetic and pre-diabetic subjects: Shanghai diabetic complications study. Diabetes Metab Res Rev 28:276–283CrossRefGoogle Scholar
  24. 24.
    Liu KH, Chu WC, Kong AP et al (2013) Intrarenal arterial resistance is associated with microvascular complications in Chinese type 2 diabetic patients. Nephrol Dial Transpl 28:651–658CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Huiyan Zhang
    • 1
  • Jianyong Wang
    • 2
  • Gui-shuang Ying
    • 3
  • Liping Shen
    • 2
  • Zhe Zhang
    • 4
  1. 1.College of Professional Technology of HangzhouHangzhouPeople’s Republic of China
  2. 2.Department of Ophthalmology, The First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople’s Republic of China
  3. 3.Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of Endocrinology, The First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople’s Republic of China

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