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
- Giuseppe Penno, MD1,
- Anna Solini, MD, PHD2,
- Giacomo Zoppini, MD3,
- Emanuela Orsi, MD4,
- Gianpaolo Zerbini, MD5,
- Roberto Trevisan, MD, PHD6,
- Gabriella Gruden, MD, PHD7,
- Franco Cavalot, MD8,
- Luigi Laviola, MD, PHD9,
- Susanna Morano, MD10,
- Antonio Nicolucci, MD, PHD11,
- Giuseppe Pugliese, MD, PHD12⇓ and
- for the Renal Insufficiency And Cardiovascular Events (RIACE) Study Group*
- 1Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy; the
- 2Department of Internal Medicine, University of Pisa, Pisa, Italy
- 3Division of Endocrinology and Metabolic Diseases, University of Verona, Verona, Italy the
- 4Department of Medical Sciences, the Endocrinology and Diabetes Unit, Fondazione IRCCS, Cà Granda – Ospedale Maggiore Policlinico, Milan, Italy the
- 5Complications of Diabetes Unit, Division of Metabolic and Cardiovascular Sciences, San Raffaele Scientific Institute, Milan, Italy the
- 6Diabetes Unit, Hospital of Bergamo, Bergamo, Italy the
- 7Department of Internal Medicine, University of Turin, Turin, Italy the
- 8Department of Clinical and Biological Sciences, the Unit of Internal Medicine, University of Turin, Turin, Italy
- 9Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy the
- 10Department of Internal Medicine and Medical Specialties, La Sapienza University, Rome, Italy the
- 11Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Chieti, Italy the
- 12Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy
- Corresponding author: Giuseppe Pugliese, .
OBJECTIVE To evaluate the rate and determinants of concordance between advanced diabetic retinopathy (DR) and chronic kidney disease (CKD), as assessed by both albuminuria and estimated glomerular filtration rate (eGFR), in the large cohort of the Renal Insufficiency And Cardiovascular Events (RIACE) Italian multicenter study.
RESEARCH DESIGN AND METHODS Patients with type 2 diabetes (n = 15,773) visiting consecutively 19 hospital–based diabetes clinics in years 2007 and 2008 were examined. DR was assessed by dilated fundoscopy. CKD was defined based on albuminuria and eGFR.
RESULTS CKD was present in 58.64% of subjects with advanced DR, whereas advanced DR was detectable only in 15.28% of individuals with any CKD and correlated with the albuminuric CKD phenotypes more than with the nonalbuminuric phenotype. Age, male sex, diabetes duration, hemoglobin A1c, hypertension, triglycerides, previous cardiovascular disease, and, inversely, HDL-cholesterol correlated independently with the presence of any CKD in individuals with advanced DR; correlates differed according to the presence of albuminuria, reduced eGFR, or both. Conversely, factors associated with the presence of advanced DR in subjects with any CKD were diabetes treatment, previous cardiovascular disease, albuminuria, and, inversely, smoking, eGFR, and age at diagnosis.
CONCLUSIONS Concordance of CKD with advanced DR is low in subjects with type 2 diabetes, and CKD without advanced DR is more frequent than isolated advanced DR, at variance with type 1 diabetes. Factors independently associated with the presence of any CKD in individuals with advanced DR differ, at least in part, from those correlating with the presence of advanced DR in subjects with any CKD and by CKD phenotype.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc12-0628/-/DC1.
A slide set summarizing this article is available online.
- Received April 1, 2012.
- Accepted May 25, 2012.
- © 2012 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.