Short-term duration of diabetic retinopathy as a predictor for development of diabetic kidney disease

Jiayu Duan; Dongwei Liu; Zihao Zhao; Lulu Liang; Shaokang Pan; Fei Tian; Pei Yu; Guangpu Li; Zhangsuo Liu

doi:10.2478/jtim-2022-0074

Short-term duration of diabetic retinopathy as a predictor for development of diabetic kidney disease

J Transl Int Med. 2023 Dec 20;11(4):449-458. doi: 10.2478/jtim-2022-0074. eCollection 2023 Dec.

Authors

Jiayu Duan^{1

2

3}, Dongwei Liu^{1

2

3}, Zihao Zhao^{1

3}, Lulu Liang², Shaokang Pan^{1

2}, Fei Tian², Pei Yu³, Guangpu Li^{1

2}, Zhangsuo Liu^{1

2

3}

Affiliations

¹ Research Institute of Nephrology, Zhengzhou University, Zhengzhou 450052, Henan Province, China.
² TCM-Integrated Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
³ Henan Province Research Center for Kidney Disease, Zhengzhou 450052, Henan Province, China.

Abstract

Background: Diabetic retinopathy (DR) is a risk factor for diabetic kidney disease (DKD). Whether the duration, especially the short-term duration, of DR is associated with the development and progression of DKD remains unclear.

Materials and methods: A retrospective study and two-sample Mendelian randomization (MR) analysis were conducted. Kidney disease was defined by the urinary albumin-to-creatinine ratio (ACR) and the estimated glomerular filtration rate (eGFR). DR was diagnosed by an expert ophthalmologist by using a digital fundus camera. Binary and ordinal logistic regression analyses were performed. A restricted cubic spline was utilized to detect nonlinear associations. Summary statistics for DR- and DKD-associated single-nuclear polymorphisms (SNPs) were extracted from the FinnGen and the UK Biobank consortia.

Results: A total of 2674 patients with type 2 diabetes mellitus (T2DM) and type 2 diabetic kidney disease (T2DKD) were included. The prevalence and mean duration of DR increased with elevation of ACR and decline in eGFR. Renal function was significantly reduced in patients with DR in the fifth year of life. Binary and ordinal logistic regression showed that each 1-year increase in DR duration was associated with a 19% risk increase in the development of DKD, 16% in the elevation of ACR, and 21% in the decline of renal function. MR estimates indicated that DR was causally associated with DKD development, with an odds ratio of 2.89.

Conclusions: DR and the duration of DR were independent risk factors for the development and progression of DKD. The short-term duration of DR may be associated with DKD development. DR had a statistically significant effect on DKD.

Keywords: Mendelian randomization; causal effect; diabetic kidney disease; diabetic retinopathy.

Grants and funding

This study was supported by the National Natural Science Young Scientists Foundation of China (grant no. 82103916), the General Program of the National Natural Science Foundation of China General Project (grant no. 81970633), and major public welfare special projects in Henan Province (grant no. 201300310600).