The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes

Author:

Bermejo Sheila123ORCID,González Ester4,López-Revuelta Katia5,Ibernon Meritxell6,López Diana7,Martín-Gómez Adoración8,Garcia-Osuna Rosa9,Linares Tania10,Díaz Montserrat11,Martín Nàdia12,Barros Xoana12,Marco Helena1113,Navarro Maruja Isabel13,Esparza Noemí14,Elias Sandra15,Coloma Ana1617,Robles Nicolás Roberto18,Agraz Irene12,Poch Esteban1920,Rodas Lida1920,Lozano Víctor1920,Fernández-Fernández Beatriz21,Hernández Eduardo4,Martínez Maria Isabel5,Stanescu Ramona Ionela5,Moirón José Pelayo7,García-Fernández Núria7,Goicoechea Marian10,Calero Francesca11,Bonet Josep13,Liaño Fernando22,Pascual Julio3,Bestard Oriol12,Praga Manuel4,Fulladosa Xavier17,Soler María José123

Affiliation:

1. Nephrology Department, Hospital Vall d'Hebron , Barcelona , Spain

2. Vall d’Hebron Research Institute , Barcelona , Spain

3. Nephrology Department , Hospital del Mar, Barcelona , Spain

4. Nephrology Department, Hospital 12 de Octubre , Madrid , Spain

5. Nephrology Department, Hospital Universitario Fundación Alcorcón , Madrid , Spain

6. Nephrology Department, Hospital Sant Joan Despí Moisès Broggi , Barcelona , Spain

7. Nephrology Department, Clínica Universidad de Navarra , Pamplona , Spain

8. Nephrology Department, Hospital de Poniente , Almería , Spain

9. Nephrology Department, Hospital de Palamós , Girona , Spain

10. Nephrology Department, Hospital Universitario Gregorio Marañón , Madrid , Spain

11. Nephrology Department , Fundació Puigvert, Barcelona , Spain

12. Nephrology Department, Hospital Universitari Josep Trueta , Girona , Spain

13. Nephrology Department, Hospital Germans Trias i Pujol , Badalona , Spain

14. Nephrology Department, Hospital Universitario Insular de Gran Canaria , Las Palmas de Gran Canaria , Spain

15. Nephrology Department, Hospital Universitario Ramón y Cajal , Madrid , Spain

16. Nephrology Department, Hospital San Pedro , Logroño , Spain

17. Nephrology Department, Hospital de Bellvitge, Hospitalet de Llobregat , Barcelona , Spain

18. Nephrology Department, Hospital Infanta Cristina , Badajoz , Spain

19. Nephrology Department, Hospital Clínic , Barcelona , Spain

20. IDIBAPS, Universitat de Barcelona , Barcelona , Spain

21. Nephrology Department , IIS-Fundación Jiménez Díaz, Madrid , Spain

22. Instituto Ramón y Cajal de Investigación Sanitaria , Madrid , Spain

Abstract

ABSTRACT Background Up to 50–60% of patients with diabetes have non-diabetic kidney disease (NDKD) on kidney biopsy. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the kidney outcomes and survival in patients with biopsy diagnoses of DN and NDKD according to the presence of DR. Methods We conducted an observational, multicentre and retrospective study of the pathological findings of renal biopsies from 832 consecutive patients with diabetes from 2002 to 2014 from 18 nephrology departments. The association of DR with kidney replacement therapy (KRT) or survival was assessed by Kaplan–Meier and Cox regression analyses. Results Of 832 patients with diabetes and renal biopsy, 768 had a retinal examination and 221/768 (22.6%) had DR. During a follow-up of 10 years, 288/760 (37.9%) patients with follow-up data needed KRT and 157/760 (20.7%) died. The incidence of KRT was higher among patients with DN (alone or with NDKD) and DR [103/175 (58.9%)] than among patients without DR [88/216 (40.7%), P < .0001]. The incidence of KRT was also higher among patients with only NDKD and DR than among those without DR [18/46 (39.1%) versus 79/331 (23.9%), P < .0001]. In multivariate analysis, DR or DN were independent risk factors for KRT {hazard ratio [HR] 2.48 [confidence interval (CI) 1.85–3.31], P < .001}. DN (with or without DR) was also identified as an independent risk factor for mortality [HR 1.81 (CI 1.26–2.62), P = .001]. Conclusions DR is associated with a higher risk of progression to kidney failure in patients with histological DN and in patients with NDKD.

Funder

Fondo de Investigación Sanitaria-FEDER

ISCIII

Marató

BECA SENEFRO

Publisher

Oxford University Press (OUP)

Subject

Transplantation,Nephrology

Reference18 articles.

1. Renal biopsy in type 2 diabetic patients;Espinel;J Clin Med,2015

2. The current role of renal biopsy in diabetic patients;Bermejo;Minerva Med,2018

3. Risk factors for non-diabetic renal disease in diabetic patients;Bermejo;Clin Kidney J,2020

4. Complications of diabetes 2016;Papatheodorou;J Diabetes Res,2016

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