Time-sequential correlations between diabetic kidney disease and diabetic retinopathy in type 2 diabetes - an 8-year prospective cohort study

Purpose: To investigate the time-sequential correlations between progression/remission of diabetic kidney disease (DKD) and development of diabetic retinopathy (DR) or diabetic macular oedema (DME) in type 2 diabetes (T2D).

Methods: This was an 8-year prospective cohort study in which 576 patients with T2D and microalbuminuria from one medical centre in Taiwan were recruited. Progression of microalbuminuria was defined as shift of urinary albumin/creatinine ratio (ACR) into 300 mg/g or more; remission of microalbuminuria was defined as having a urinary ACR less than 30 mg/g in at least two of three tests over a period of 6 months. Cox regression analysis was used to evaluate the hazard ratios (HRs) for progression or remission of microalbuminuria on development of any DR, proliferative DR (PDR) and DME.

Results: After adjusting for baseline characteristics , remission of microalbuminuria was a significant protecting factor for development of PDR (HR = 0.290, 95% CI: 0.102-0.826, p = 0.020) and DME (HR = 0.404, 95% CI: 0.188-0.864, p = 0.020). After further adjustment for the mean follow-up HbA1c and systolic blood pressure, remission of microalbuminuria was still a significant protecting factor for development of PDR (HR = 0.348, 95% CI: 0.122-0.992, p = 0.048).

Conclusions: Remission of microalbuminuria was an independent protecting factor for development of PDR and DME. Aggressive treatment for DKD might help prevent the progression of DR.

Keywords: diabetes mellitus; diabetic kidney disease; diabetic macular edema; diabetic retinopathy.