The occurrence of various grades of diabetic retinopathy in patients with end stage renal disease in a tertiary hospital

Abstract

The aim of this study was to assess the severity of fundus findings in patients with End Stage Renal Disease (ESRD) in a tertiary hospital in South India. One hundred and forty eight eyes of 74 patients with ESRD were enrolled in the study after obtaining the informed consent. Complete history was taken, ocular examination including visual acuity and Intraocularpressure were recorded. Anterior segment examination using slit lamp bio microscopy, fundus examination using indirect ophthalmoscope and slit lamp biomicroscopy with 90 D lens were performed. Fundus photograph was captured. Data was analysed using SPSS v 25.0.0.0. In this study, 25% were females while 75% were males. 24% of the males had PDR while none of the females had PDR. Six percent of the males had mild to moderate NPDR, while 11% of females had mild to moderate NPDR.(P =0.043). Younger patients with end stage renal disease were found to have a higher propensity of having proliferative diabetic retinopathy (p=0.014). Patients who were undergoing dialysis for 5 years or more, had an incidence of PDR of 30%, while those undergoing dialysis for less than 5 years had an incidence of PDR of 15% (p= 0.468). Ten percent of those with 5 years or more of dialysis had mild-moderate NPDR, while 6.8% of those with less than 5 years of dialysis had mild-moderate NPDR. In our subset of patients, dialysis was performed either twice or thrice a week. Those with the former, had an incidence 10. 9% of PDR, while those with the latter had an incidence of 31.8% of PDR. (p=0.156). Patients who had undergone cataract surgery had a higher incidence of diabetic retinopathychanges, especially proliferative diabetic retinopathy (p=0.00). The presence and severity of retinopathy intimately associates with CKD progression among all diabetes patients with chronic kidney diseases. Routine follow-up and management of ocular and retinal disorders in CKD patients with diabetes would be important for aggressive management of diabetic retinopathy and prevention of CKD progression among these patients.