The association of retinopathy and low GFR in type 2 diabetes

• Published in: Diabetes research and clinical practice Vol. 98; no. 3; pp. 487 - 493
• Main Authors: Mottl, A.K, Kwon, K.S, Garg, S, Mayer-Davis, E.J, Klein, R, Kshirsagar, A.V
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.12.2012
• Subjects: Adult; African Americans; Aged; Aged, 80 and over; Albuminuria; Albuminuria - etiology; Biomarkers; Body Mass Index; Cross-Sectional Studies; Diabetes Mellitus, Type 2 - complications; Diabetic Nephropathies - complications; Diabetic Nephropathies - ethnology; Diabetic Nephropathies - physiopathology; Diabetic Retinopathy - complications; Diabetic Retinopathy - ethnology; Diabetic Retinopathy - pathology; Diabetic Retinopathy - physiopathology; Endocrinology & Metabolism; Ethnicity; Female; Glomerular Filtration Rate; Health Surveys; Humans; Kidney - physiopathology; Male; Middle Aged; Nephropathy; Obesity; Obesity - complications; Retina - pathology; Retinopathy; Severity of Illness Index; United States; United States; Obesity; Ethnicity; Retinopathy; Nephropathy; Albuminuria
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2012.09.041

Abstract Aims We sought to determine characteristics which strengthen the association between markers of diabetic kidney disease and retinopathy. Methods Multivariate regression analyses of NHANES 2005–2008 assessed the association of retinopathy with renal insufficiency and albuminuria. Analyses were stratified to evaluate ethnicity/race, obesity, and use of renin–angiotensin–aldosterone system antagonists as effect modifiers of this relationship. Results Of 269 participants with renal insufficiency, 35% had no microalbuminuria and no retinopathy; 16.1% had retinopathy with no microalbuminuria; 27.1% had microalbuminuria and no retinopathy and 22% had both microalbuminuria and retinopathy. Stratified, multivariate logistic regression analyses demonstrated retinopathy to be significantly predictive of renal insufficiency only in nonHispanic Blacks (OR = 2.7; 95% CI 1.2, 6.1), obesity (OR = 2.6; 95% CI 1.3, 5.5) and in those participants not using renin–angiotensin–aldosterone blockers (OR = 2.5; 95% CI 1.1, 5.7). Analyses showed an independent relationship between retinopathy and albuminuria only when albuminuria was modeled continuously. Conclusions In older onset diabetes, the absence of albuminuria and retinopathy is common among individuals with renal insufficiency. The relationship between microvascular complications of the eye and kidney may vary according to ethnicity, obesity and use of renin–angiotensin–aldosterone antagonists. These findings need to be confirmed in other large, diverse cohorts.