Chronic Kidney Disease and Diabetic Retinopathy in Patients with Type 2 Diabetes

To explore the relationship between chronic kidney disease (CKD) and diabetic retinopathy (DR) in a representative population of type 2 diabetes mellitus (DM2) patients in Catalonia (Spain). This was a population-based, cross-sectional study. A total of 28,344 patients diagnosed with DM2 who had recorded ophthalmologic and renal functional examinations were evaluated. Data were obtained from a primary healthcare electronic database of medical records. CKD was defined as an estimated glomerular filtration ratio (eGFR) of <60 ml/min/1.73m 2 and/or urine albumin to creatinine ratio (UACR) ≥30 mg/g. DR was categorized as non-vision threatening diabetic retinopathy and vision threatening diabetic retinopathy. CKD was associated with a higher rate of DR [OR], 95% confidence interval [CI], 1.5 (1.4-1.7). When we analyzed the association between different levels of UACR and DR prevalence observed that DR prevalence rose with the increase of UACR levels, and this association was significant from UACR values ≥10 mg/g, and increased considerably with UACR values ≥300mg/g (Odds ratio [OR], 95% confidence interval [CI], 2.0 (1.6-2.5). This association was lower in patients with eGFR levels 44 to 30 mL/min/1.73m 2 [OR], 95% confidence interval [CI], 1.3 (1.1-1.6). These results show that CKD, high UACR and/or low eGFR, appear to be associated with DR in this DM2 population

Guia per a l'optimització de la utilització de proves diagnòstiques

Atenció sanitària basada en el valor; Proves diagnòstiques; EficiènciaAtención sanitaria basada en el valor; Pruebas diagnósticas; EficienciaValue-Based Healthcare; Diagnostic tests; EfficiencyAquesta guia s´ha creat per homogeneïtzar criteris i adequar la utilització de proves diagnòstiques en l'atenció als pacients. Aquesta adequació es fa d'acord amb la cartera de serveis específica de l'Atenció Primària i també en els processos assistencials compartits amb d'altres àmbits assistencials del territori.Esta guía se ha creado para homogeneizar criterios y adecuar la utilización de pruebas diagnósticas en la atención a los pacientes. Esta adecuación se hace de acuerdo con la cartera de servicios específica de la Atención Primaria y también en los procesos asistenciales compartidos con otros ámbitos asistenciales del territorio.This guide has been created to standardize criteria and adapt the use of diagnostic tests in patient care. This adjustment is made in accordance with the specific portfolio of Primary Care services and also in the care processes shared with other care areas in the territory

Chronic Kidney Disease and Diabetic Retinopathy in Patients with Type 2 Diabetes.

PURPOSE:To explore the relationship between chronic kidney disease (CKD) and diabetic retinopathy (DR) in a representative population of type 2 diabetes mellitus (DM2) patients in Catalonia (Spain). METHODS:This was a population-based, cross-sectional study. A total of 28,344 patients diagnosed with DM2 who had recorded ophthalmologic and renal functional examinations were evaluated. Data were obtained from a primary healthcare electronic database of medical records. CKD was defined as an estimated glomerular filtration ratio (eGFR) of <60 ml/min/1.73 m2 and/or urine albumin to creatinine ratio (UACR) ≥30 mg/g. DR was categorized as non-vision threatening diabetic retinopathy and vision threatening diabetic retinopathy. RESULTS:CKD was associated with a higher rate of DR [OR], 95% confidence interval [CI], 1.5 (1.4-1.7). When we analyzed the association between different levels of UACR and DR prevalence observed that DR prevalence rose with the increase of UACR levels, and this association was significant from UACR values ≥10 mg/g, and increased considerably with UACR values ≥300 mg/g (Odds ratio [OR], 95% confidence interval [CI], 2.0 (1.6-2.5). This association was lower in patients with eGFR levels 44 to 30 mL/min/1.73 m2 [OR], 95% confidence interval [CI], 1.3 (1.1-1.6). CONCLUSIONS:These results show that CKD, high UACR and/or low eGFR, appear to be associated with DR in this DM2 population

Patients’ characteristics with respect to diabetic retinopathy.

<p>Patients’ characteristics with respect to diabetic retinopathy.</p

Patients’ characteristics with respect to glomerular filtration rate (eGFR).

<p>Patients’ characteristics with respect to glomerular filtration rate (eGFR).</p

Association of chronic kidney disease and diabetic retinopathy.

<p>*Adjusted by sex, age at digital photography, duration of type 2 diabetes, systolic blood pressure <140 mmHg, and A1C ≤7%; DR, diabetic retinopathy; eGFR, estimated glomerular filtration rate; UACR, urine albumin to creatinine ratio; VTDR, vision threatening diabetic retinopathy (severe non proliferative DR, proliferative DR, and diabetic macular edema); non-VTDR, mild non-proliferative DR and moderate non-proliferative DR.</p

Urine albumin to creatinine ratio and prevalence of diabetic retinopathy.

<p>*Adjusted by age, sex, age at retinography, duration type 2 diabetes, systolic blood pressure <140 mmHg, A1C ≤ 7%, smoking, cardiovascular disease, BMI, and eGFR. DR, diabetic retinopathy; OR, odds ratio; UACR, urine albumin to creatinine ratio.</p

Patients’ characteristics with respect to urine albumin to creatinine ratio (UACR).

<p>Patients’ characteristics with respect to urine albumin to creatinine ratio (UACR).</p