Department of Ophthalmology, Goethe-University, Theodor Stern Kai 7, 60590, Frankfurt am Main, Germany.
Herzog Carl Theodor Eye Clinic, Munich, Germany.
Sci Rep. 2020 Aug 25;10(1):14158. doi: 10.1038/s41598-020-70998-9.
There is limited knowledge on the prevalence and risk factors of diabetic retinopathy (DR) in dialysis patients. We have investigated the association between diabetes mellitus and lipid-related biomarkers and retinopathy in hemodialysis patients. We reviewed 1,255 hemodialysis patients with type 2 diabetes mellitus (T2DM) who participated in the German Diabetes and Dialysis Study (4D Study). Associations between categorical clinical, biochemical variables and diabetic retinopathy were examined by logistic regression. On average, patients were 66 ± 8 years of age, 54% were male and the HbA1c was 6.7% ± 1.3%. DR, found in 71% of the patients, was significantly and positively associated with fasting glucose, HbA1c, time on dialysis, age, systolic blood pressure, body mass index and the prevalence of other microvascular diseases (e.g. neuropathy). Unexpectedly, DR was associated with high HDL cholesterol and high apolipoproteins AI and AII. Patients with coronary artery disease were less likely to have DR. DR was not associated with gender, smoking, diastolic blood pressure, VLDL cholesterol, triglycerides, and LDL cholesterol. In summary, the prevalence of DR in patients with type 2 diabetes mellitus requiring hemodialysis is higher than in patients suffering from T2DM, who do not receive hemodialysis. DR was positively related to systolic blood pressure (BP), glucometabolic control, and, paradoxically, HDL cholesterol. This data suggests that glucose and blood pressure control may delay the development of DR in patients with diabetes mellitus on dialysis.
关于透析患者中糖尿病视网膜病变（DR）的患病率和风险因素知之甚少。我们研究了糖尿病和与脂质相关的生物标志物与血液透析患者视网膜病变之间的关系。我们回顾了参加德国糖尿病与透析研究（4D 研究）的 1255 例 2 型糖尿病（T2DM）血液透析患者。通过逻辑回归检查分类临床、生化变量与糖尿病视网膜病变之间的关联。平均而言，患者年龄为 66±8 岁，54%为男性，HbA1c 为 6.7%±1.3%。71%的患者存在 DR，其与空腹血糖、HbA1c、透析时间、年龄、收缩压、体重指数和其他微血管疾病（如神经病变）的患病率呈显著正相关。出乎意料的是，DR 与 HDL 胆固醇和载脂蛋白 AI 和 AII 升高相关。患有冠心病的患者发生 DR 的可能性较小。DR 与性别、吸烟、舒张压、VLDL 胆固醇、甘油三酯和 LDL 胆固醇无关。总之，需要血液透析的 2 型糖尿病患者中 DR 的患病率高于未接受血液透析的 T2DM 患者。DR 与收缩压（BP）、糖代谢控制呈正相关，而且与 HDL 胆固醇呈正相关，这令人意外。这些数据表明，血糖和血压控制可能会延缓糖尿病透析患者 DR 的发展。
