Mori Tomomi, Hanai Ko, Yamamoto Yui, Yoshida Naoshi, Murata Hidekazu, Nakagami Tomoko
Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666, Japan.
Clin Exp Nephrol. 2025 May;29(5):607-615. doi: 10.1007/s10157-024-02599-z. Epub 2024 Dec 26.
Whether diabetic retinopathy (DR) can predict kidney disease progression in individuals with diabetes remains unclear. Furthermore, there are only a limited number of studies investigating the association between DR and kidney outcomes classified according to baseline kidney function and albuminuria status. Here, we examined the association of DR with kidney disease progression in individuals with type 2 diabetes.
This retrospective cohort study included 6759 Japanese adults with type 2 diabetes (36.3% women). Kidney insufficiency and albuminuria were defined as eGFR < 60 mL/min/1.73 m and urinary albumin-to-creatinine ratio ≥ 30 mg/g, respectively. The exposure and outcome were baseline DR and the composite of eGFR halving or the initiation of kidney replacement therapy, respectively. The hazard ratios for the outcome were estimated using the multivariable Cox proportional hazards model.
During the median follow-up period of 8.4 years, 922 reached the outcome. Among the individuals without kidney insufficiency, those with DR at baseline had a significantly higher incidence of the outcome than those without DR regardless of baseline albuminuria status (p < 0.05), whereas the presence of DR was not the risk factor among individuals with kidney insufficiency. There was an interaction between baseline DR and kidney insufficiency with respect to the outcome incidence (p = 0.043). When baseline eGFRs were classified into eGFR categories based on the Kidney Disease: Improving Global Outcomes guideline, the above findings were more clearly shown.
DR may be able to predict kidney disease progression only among individuals with type 2 diabetes exhibiting preserved kidney function.
糖尿病视网膜病变（DR）能否预测糖尿病患者的肾病进展尚不清楚。此外，仅有少数研究调查了DR与根据基线肾功能和蛋白尿状态分类的肾脏结局之间的关联。在此，我们研究了2型糖尿病患者中DR与肾病进展的关联。
这项回顾性队列研究纳入了6759名日本成年2型糖尿病患者（女性占36.3%）。肾功能不全和蛋白尿分别定义为估算肾小球滤过率（eGFR）<60 mL/min/1.73 m²和尿白蛋白与肌酐比值≥30 mg/g。暴露因素和结局分别为基线DR和eGFR减半或开始肾脏替代治疗的复合情况。使用多变量Cox比例风险模型估计结局的风险比。
在中位随访期8.4年期间，922人达到了该结局。在没有肾功能不全的个体中，无论基线蛋白尿状态如何，基线时有DR的个体发生该结局的发生率显著高于无DR者（p<0.05），而在肾功能不全的个体中，DR的存在不是风险因素。关于结局发生率，基线DR和肾功能不全之间存在交互作用（p = 0.043）。当根据《改善全球肾脏病预后组织》指南将基线eGFR分类为eGFR类别时，上述结果更为明显。
DR可能仅能在肾功能保留的2型糖尿病个体中预测肾病进展。
