Associations of renal function with diabetic retinopathy and visual impairment in type 2 diabetes: A multicenter nationwide cross-sectional study

doi:10.5527/wjn.v8.i2.33

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World Journal of Nephrology

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2220-6124

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Nephrol. Feb 21, 2019; 8(2): 33-43
Published online Feb 21, 2019. doi: 10.5527/wjn.v8.i2.33

Table 1 Baseline characteristics n (%)

Characteristics	All	eGFR (mL/min/1.73 m²)				P-value
Characteristics	All	≥ 90	60-89	30-59	< 30	P-value
N	13192	2979 (22.6)	4870 (36.9)	4397 (33.3)	946 (7.2)
Age (yr), mean ± SD	60.7 ± 10.3	54.1 ± 8.5	59.4 ± 9.6	65.4 ± 9.2	66.0 ± 10.0	< 0.001
Male	4012 (30.4)	860 (28.9)	1587 (32.6)	1303 (29.6)	262 (27.7)	< 0.001
Duration of diabetes (yr), mean ± SD	7.4 ± 4.8	6.1 ± 4.1	7.0 ± 4.5	8.3 ± 5.1	9.1 ± 5.4	< 0.001
Waist circumference (cm), mean ± SD	88.6 ± 10.4	88.9 ± 10.6	88.7 ± 10.3	88.5 ± 10.3	87.4 ± 101.6	< 0.01
Hypertension	9741 (73.8)	1935 (65.0)	3466 (71.2)	3575 (81.3)	765 (80.9)	< 0.001
Smoking	467 (3.5)	127 (4.3)	203 (4.2)	117 (2.7)	20 (2.1)	< 0.001
CAD	621 (4.7)	76 (2.6)	205 (4.2)	269 (6.1)	71 (7.5)	< 0.001
CVD	273 (2.1)	42 (1.4)	94 (1.9)	104 (2.4)	33 (3.5)	< 0.001
PAD	24 (0.2)	5 (0.2)	5 (0.1)	8 (0.2)	6 (0.6)	< 0.01
Antiplatelets	8067 (61.4)	1569 (52.9)	2974 (61.3)	2923 (66.8)	601 (64.0)	< 0.001
Metformin	9756 (74.0)	2592 (87.0)	4066 (83.5)	2894 (65.8)	204 (21.6)	< 0.001
Sulfonylurea	8751 (66.3)	2070 (69.5)	3460 (71.0)	2882 (65.5)	339 (35.8)	< 0.001
Insulin	2866 (21.7)	493 (16.5)	765 (15.7)	1050 (23.9)	558 (59.0)	< 0.001

eGFR: Estimated glomerular filtration rate; CAD: Coronary artery diseases; CVD: Cerebrovascular diseases; PAD: Peripheral artery disease.

Table 2 Prevalence and severity of diabetic retinopathy stratified by estimated glomerular filtration rate level (mL/min/1.73 m²) n (%)

Outcomes	All	eGFR (mL/min/1.73 m²)				P-value
Outcomes	All	≥ 90	60-89	30-59	< 30	P-value
DR	1636 (12.4)	284 (9.5)	534 (11.0)	620 (14.1)	198 (20.9)	< 0.001
Non-proliferative DR	1313 (10.0)	242 (8.1)	438 (9.0)	498 (11.3)	135 (14.3)	< 0.001
Proliferative DR	240 (1.8)	33 (1.1)	63 (1.3)	95 (2.2)	49 (5.2)	< 0.001
Diabetic macular edema	21 (0.2)	1 (0.0)	8 (0.2)	8 (0.2)	4 (0.4)	0.06
Non-specific DR	84 (0.6)	9 (0.3)	33 (0.7)	27 (0.6)	15 (1.6)	< 0.001
Severe DR	258 (2.0)	34 (1.1)	70 (1.4)	102 (2.3)	52 (5.5)	< 0.001
Severe visual impairment	281 (2.1)	24 (0.8)	72 (1.5)	140 (3.2)	45 (4.8)	< 0.001
Counting finger	138 (1.0)	7 (0.2)	43 (0.9)	72 (1.6)	16 (1.7)	< 0.001
Hand movement	77 (0.6)	10 (0.3)	17 (0.3)	35 (0.8)	15 (1.6)	< 0.001
Projection of light	14 (0.1)	0 (0)	5 (0.1)	6 (0.1)	3 (0.3)	0.06
No light perception	56 (0.4)	7 (0.2)	8 (0.2)	30 (0.7)	11 (1.2)	< 0.001

DR: Diabetic retinopathy; eGFR: Estimated glomerular filtration rate.

Table 3 Association of estimated glomerular filtration rate level and diabetic retinopathy

eGFR (mL/min/1.73m²)	Crude OR	95%CI	P-value	Adjusted OR¹	95%CI	P-value
≥ 90	1 (reference)			1 (reference)
60-89	1.17	1.01-1.36	0.04	1.36	1.12-1.65	< 0.01
30-59	1.56	1.34-1.81	< 0.001	2.08	1.70-2.55	< 0.001
< 30	2.51	2.06-3.06	< 0.001	2.38	1.79-3.18	< 0.001

¹Adjusted for age, gender, duration of diabetes, waist circumference, hypertension, smoking, coronary artery diseases, cerebrovascular diseases, peripheral artery disease, antiplatelet, metformin, sulfonylurea, and insulin. eGFR: Estimated glomerular filtration rate.

Table 4 Subgroup analysis comparing the association of estimated glomerular filtration rate level with severe diabetic retinopathy and severe visual impairment

eGFR (mL/min/1.73 m²)	Crude OR	95%CI	P-value	Adjusted OR¹	95%CI	P-value
Proliferative diabetic retinopathy and macular edema
≥ 90	1 (reference)			1 (reference)
60-89	1.26	0.84-1.91	0.27	1.95	1.14-3.33	0.02
30-59	2.06	1.39-3.04	< 0.001	2.82	1.61-4.93	< 0.001
< 30	5.04	3.25-7.81	< 0.001	4.89	2.47-9.67	< 0.001
Severe visual impairment
≥ 90	1 (reference)			1 (reference)
60-89	1.85	1.16-2.94	0.01	1.07	0.62-1.82	0.81
30-59	4.05	2.62-6.26	< 0.001	2.06	1.22-3.46	< 0.01
< 30	6.15	3.73-10.15	< 0.001	2.50	1.31-4.76	< 0.01

Citation: Kaewput W, Thongprayoon C, Rangsin R, Ruangkanchanasetr P, Mao MA, Cheungpasitporn W. Associations of renal function with diabetic retinopathy and visual impairment in type 2 diabetes: A multicenter nationwide cross-sectional study. World J Nephrol 2019; 8(2): 33-43
URL: https://www.wjgnet.com/2220-6124/full/v8/i2/33.htm
DOI: https://dx.doi.org/10.5527/wjn.v8.i2.33