The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes
Sheila Bermejo, Ester González, Katia Lopez‐Revuelta, Meritxell Ibernón, Diana López, Adoración Martín-Gómez, Rosa García-Osuna, Tania Liñares, Montserrat Díaz, Nàdia Martín, Xoana Barros, Helena Marco, Maruja Navarro, Noemí Esparza, Sandra Elías, Ana Coloma, Nicolás Roberto Robles, Irene Agraz, Esteban Poch, Lida Rodas, Víctor Lozano, Beatriz Fernández‐Fernández, Eduardo Hernández, María Isabel Martínez, Ramona Ionela Stanescu, José Pelayo Moirón, Nuria Garcı́a-Fernández, Marián Goicoechea, Francesca Calero, Josep Bonet, Fernando Liaño, Julio Pascual, Oriol Bestard, Manuel Praga, Xavier Fulladosa, María José Soler
Abstract
ABSTRACT Background Up to 50–60% of patients with diabetes have non-diabetic kidney disease (NDKD) on kidney biopsy. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the kidney outcomes and survival in patients with biopsy diagnoses of DN and NDKD according to the presence of DR. Methods We conducted an observational, multicentre and retrospective study of the pathological findings of renal biopsies from 832 consecutive patients with diabetes from 2002 to 2014 from 18 nephrology departments. The association of DR with kidney replacement therapy (KRT) or survival was assessed by Kaplan–Meier and Cox regression analyses. Results Of 832 patients with diabetes and renal biopsy, 768 had a retinal examination and 221/768 (22.6%) had DR. During a follow-up of 10 years, 288/760 (37.9%) patients with follow-up data needed KRT and 157/760 (20.7%) died. The incidence of KRT was higher among patients with DN (alone or with NDKD) and DR [103/175 (58.9%)] than among patients without DR [88/216 (40.7%), P < .0001]. The incidence of KRT was also higher among patients with only NDKD and DR than among those without DR [18/46 (39.1%) versus 79/331 (23.9%), P < .0001]. In multivariate analysis, DR or DN were independent risk factors for KRT {hazard ratio [HR] 2.48 [confidence interval (CI) 1.85–3.31], P < .001}. DN (with or without DR) was also identified as an independent risk factor for mortality [HR 1.81 (CI 1.26–2.62), P = .001]. Conclusions DR is associated with a higher risk of progression to kidney failure in patients with histological DN and in patients with NDKD.