Fitzgerald Ashley, Das Ryan, Moezzi Cody J, Salazar Savannah R, Mankad Rushi, Qualls Clifford R, Cabrera Andrea, Kathuria Ayushi, Monickaraj Finny, Tzamaloukas Antonios, Das Arup
Department of Ophthalmology and Visual Sciences, University of New Mexico School of Medicine, Albuquerque, NM, United States.
Ophthalmology Service, New Mexico Veterans Affairs (VA) Health Care System, Albuquerque, NM, United States.
Front Endocrinol (Lausanne). 2025 Aug 1;16:1638415. doi: 10.3389/fendo.2025.1638415. eCollection 2025.
Although diabetic retinopathy (DR) and diabetic nephropathy (DN) are well known microvascular complications of diabetes, the correlation between DR and DN remains uncertain. Several studies have suggested differences in etiology and risk factors between these two complications.
To examine whether diabetic retinopathy (DR) and nephropathy (DN) have significant concordance in terms of severity progression in patients with type 2 diabetes.
A case-control study was conducted involving two cohorts of type 2 diabetic patients from a New Mexican population. The cases had confirmed end-stage renal disease (ESRD; Stage 5, on dialysis, GFR < 15 mL/min, n = 164), while the controls had mild diabetic nephropathy (DN) (Stage 1 or Stage 2, GFR > 60 mL/min, n = 165). Systemic parameters were collected through retrospective chart reviews, which included HbA1c, blood pressure (BP), lipid levels, serum creatinine (Cr), and retinopathy status determined by dilated fundus examinations. Statistical analyses were conducted, encompassing univariate and multivariate logistic regression analyses for continuous variables, as well as a Chi-squared test for categorical variables.
The majority (65%) of the ESRD cohort had proliferative diabetic retinopathy (PDR), while 18% of patients exhibited no diabetic retinopathy (DR) or mild non-proliferative diabetic retinopathy (NPDR). Conversely, approximately 38% of the mild DN cohort had PDR. In the univariate analysis, ESRD was significantly associated with lower HbA1c levels (p<0.0001) and higher systolic blood pressure (p<0.0001). Within the ESRD cohort, the onset of PDR was significantly linked to younger age (p=0.0002), higher diastolic blood pressure (p=0.0319), and elevated LDL (p=0.0361). In the multivariate analysis, the development of PDR was inversely related to age (p=0.001, OR=0.95) and positively correlated with serum creatinine (p<0.0001, OR=1.25), systolic blood pressure (p=0.0221, OR=1.023), and albuminuria (p=0.0006, OR=4.65). HbA1c levels showed no significant correlation with the progression of PDR. The use of PDR as a screening tool for chronic kidney disease (CKD) has a sensitivity of 78.68% and a specificity of 51.16%, indicating that it is a suboptimal screening method.
Our findings suggest discordance between the progression of diabetic retinopathy and nephropathy.
尽管糖尿病视网膜病变（DR）和糖尿病肾病（DN）是糖尿病常见的微血管并发症，但DR与DN之间的相关性仍不明确。多项研究表明这两种并发症在病因和危险因素方面存在差异。
探讨2型糖尿病患者中糖尿病视网膜病变（DR）和肾病（DN）在严重程度进展方面是否具有显著一致性。
进行了一项病例对照研究，涉及来自新墨西哥州人群的两组2型糖尿病患者队列。病例组确诊为终末期肾病（ESRD；5期，接受透析，肾小球滤过率<15 mL/分钟，n = 164），而对照组患有轻度糖尿病肾病（DN）（1期或2期，肾小球滤过率>60 mL/分钟，n = 165）。通过回顾性病历审查收集全身参数，包括糖化血红蛋白（HbA1c）、血压（BP）、血脂水平、血清肌酐（Cr）以及通过散瞳眼底检查确定的视网膜病变状态。进行了统计分析，包括对连续变量的单变量和多变量逻辑回归分析，以及对分类变量的卡方检验。
ESRD队列中的大多数（65%）患有增殖性糖尿病视网膜病变（PDR），而18%的患者未出现糖尿病视网膜病变（DR）或轻度非增殖性糖尿病视网膜病变（NPDR）。相反，轻度DN队列中约38%的患者患有PDR。在单变量分析中，ESRD与较低的HbA1c水平（p<0.0001）和较高的收缩压（p<0.0001）显著相关。在ESRD队列中，PDR的发生与较年轻的年龄（p = 0.0002）、较高的舒张压（p = 0.0319）和升高的低密度脂蛋白（p = 0.0361）显著相关。在多变量分析中，PDR的发生与年龄呈负相关（p = 0.001，OR = 0.95），与血清肌酐（p<0.0001，OR = 1.25）、收缩压（p = 0.0221，OR = 1.023）和蛋白尿（p = 0.0006，OR = 4.65）呈正相关。HbA1c水平与PDR的进展无显著相关性。将PDR用作慢性肾脏病（CKD）的筛查工具，其敏感性为78.68%，特异性为51.16%，表明它是一种次优的筛查方法。
我们的研究结果表明糖尿病视网膜病变和肾病的进展不一致。
