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Kim, Kim, Kim, Shin, Kim, Lee, and Lee: The Association of Renal Function with Diabetic Retinopathy Complications
Original Article

Journal of the Korean Ophthalmological Society 2017; 58(6): 670-675.

Published online: 16 June 2017

DOI: https://doi.org/10.3341/jkos.2017.58.6.670

The Association of Renal Function with Diabetic Retinopathy Complications

So Hee Kim, MD, Eun Yeong Kim, MD, Tai Kyong Kim, MD, Hye-Young Shin, MD, PhD, Su Young Kim, MD, PhD, Young Chun Lee, MD, PhD, Mee Yon Lee, MD, PhD

Department of Ophthalmology and Visual Science, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.

Address reprint requests to Mee Yon Lee, MD, PhD. Department of Ophthalmology, The Catholic University of Korea Uijeongbu St. Mary's Hospital, #271 Cheonbo-ro, Uijeongbu 11765, Korea. Tel: 82-31-820-3022, Fax: 82-31-847-3418, deenie@hanmail.net

Received 13 October 2016       Revised 30 April 2017       Accepted 29 May 2017

©2017 The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We investigated systemic risk factors for clinically significant macula edema (CSME) within 1 year after pan-retinal photocoagulation in patients with proliferative diabetic retinopathy.

Methods

A retrospective chart review was performed on 171 patients who received pan-retinal photocoagulation at our hospital from January 2010 to December 2016. The patients were divided into Group Ⅰ with CSME (85 eyes) and Group II without CSME (86 eyes). The associations between presence of CSME and glycated hemoglobin (HbA1c), duration of diabetes, systolic and diastolic blood pressure (BP), body mass index (BMI), lipid status, sex, and estimated glomerular filtration rate (eGFR) were evaluated.

Results

In the present study of 171 patients, there was no significant difference in age and gender distribution between the two groups. Duration of diabetes, total serum cholesterol, serum low density lipoprotein, HbA1c, and eGFR were significantly higher in patients with CSME (p < 0.05). Serum high-density lipoprotein, triglycerides, BMI, and systolic and diastolic BP showed no correlation with CSME. Multiple logistic regression analysis showed that total serum cholesterol and HbA1c values had significantly high odds of developing CSME.

Conclusions

HbA1c, total serum cholesterol, and eGFR are important risk factors associated with CSME in patients with proliferative diabetic retinopathy secondary to pan-retinal photocoagulation. Thus, early detection of these risk factors and their control have significant roles in preventing the development and progression of maculopathy and thereby preventing severe visual loss.

Keywords: Clinically significant macular edema, Proliferative diabetic retinopathy, Systemic risk factors

Figures and Tables

Table 1

Comparison of proliferative diabetic retinopathy complications between two groups (according to eGFR)

jkos-58-670-i001

Values are presented as mean ± SD or n (%) unless otherwise indicated.

eGFR = excreted glomerular filtration rate; CSME = clinically significant macula edema; HbA1c = glycated hemoglobin; BP = blood pressure; BMI = body mass index; HDL = high density lipoprotein; LDL = low density lipoprotein.

*Mann Whitney U-test; †Student t-test.

Table 2

Odds ratio in recruited patients

jkos-58-670-i002

CI = confidence interval; DM = diabetes mellitus; HDL = high density lipoprotein; TG = triglyceride.

Table 3

Risk factors with significant odds ratio

jkos-58-670-i003

CI = confidence interval; OR = odds ratio.

References

1. Klein BE, Moss SE, Klein R, Surawicz TS. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XIII. Relationship of serum cholesterol to retinopathy and hard exudate. Ophthalmology. 1991; 98:1261–1265.
2. Colhoun HM, Betteridge DJ, Durrington PN, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004; 364:685–696.
3. Meyers SM. Macular edema after scatter laser photocoagulation for proliferative diabetic retinopathy. Am J Ophthalmol. 1980; 90:210–216.
4. McDonald HR, Schatz H. Visual loss following panretinal photocoagulation for proliferative diabetic retinopathy. Ophthalmology. 1985; 92:388–393.
5. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329:977–986.
6. Chew EY, Klein ML, Ferris FL 3rd, et al. Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy. Early Treatment Diabetic Retinopathy Study (ETDRS) Report 22. Arch Ophthalmol. 1996; 114:1079–1084.
7. Miljanovic B, Glynn RJ, Nathan DM, et al. A prospective study of serum lipids and risk of diabetic macular edema in type 1 diabetes. Diabetes. 2004; 53:2883–2892.
8. Asensio-Sánchez VM, Gómez-Ramírez V, Morales-Gómez I, Rodríguez-Vaca I. Clinically significant diabetic macular edema: systemic risk factors. Arch Soc Esp Oftalmol. 2008; 83:173–176.
9. Ozer PA, Unlu N, Demir MN, et al. Serum lipid profile in diabetic macular edema. J Diabetes Complications. 2009; 23:244–248.
10. Khan HA, Sobki SH, Khan SA. Association between glycaemic control and serum lipids profile in type 2 diabetic patients: HbA1c predicts dyslipidaemia. Clin Exp Med. 2007; 7:24–29.
11. Ahmad Khan H. Clinical significance of HbA1c as a marker of circulating lipids in male and female type 2 diabetic patients. Acta Diabetol. 2007; 44:193–200.
12. Man RE, Sasongko MB, Wang JJ, et al. The association of estimated glomerular filtration rate with diabetic retinopathy and macular edema. Invest Ophthalmol Vis Sci. 2015; 56:4810–4816.
13. Penno G, Solini A, Zoppini G, et al. 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. Diabetes Care. 2012; 35:2317–2323.
14. Grunwald JE, Alexander J, Ying GS, et al. Retinopathy and chronic kidney disease in the Chronic Renal Insufficiency Cohort (CRIC) study. Arch Ophthalmol. 2012; 130:1136–1144.
15. Chen H, Zheng Z, Huang Y, et al. A microalbuminuria threshold to predict the risk for the development of diabetic retinopathy in type 2 diabetes mellitus patients. PLoS One. 2012; 7:e36718.
16. Ishibazawa A, Nagaoka T, Takahashi K, et al. Association between diabetic macular edema and chronic kidney disease in patients with type 2 diabetes. Invest Ophthalmol Vis Sci. 2013; 54:2400.
17. Giorgino F, Laviola L, Cavallo Perin P, et al. Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study. Diabetologia. 2004; 47:1020–1028.
18. Perkins BA, Ficociello LH, Silva KH, et al. Regression of microalbuminuria in type 1 diabetes. N Engl J Med. 2003; 348:2285–2293.
19. Hovind P, Tarnow L, Rossing P, et al. Predictors for the development of microalbuminuria and macroalbuminuria in patients with type 1 diabetes: inception cohort study. BMJ. 2004; 328:1105.
20. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976; 16:31–41.
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