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Diabetic retinopathy is a prognostic factor for progression of chronic kidney disease in the patients with type 2 diabetes mellitus
Since both retinopathy and nephropathy are major diabetic microvascular complications, we investigated whether severity of diabetic retinopathy (DR) has adverse effects on renal function and albuminuria in the patients with type 2 diabetes mellitus (DM). We screened 2,197 adult patients with type 2...
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Published in: | PloS one 2019-07, Vol.14 (7), p.e0220506-e0220506 |
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description | Since both retinopathy and nephropathy are major diabetic microvascular complications, we investigated whether severity of diabetic retinopathy (DR) has adverse effects on renal function and albuminuria in the patients with type 2 diabetes mellitus (DM). We screened 2,197 adult patients with type 2 DM who had undergone fundus exam between August 2006 and February 2014. Among them, 1,592 subjects with available serial renal function and albuminuria measurement were included in the analysis. DR status was classified as no DR, non-proliferative DR (NPDR), and proliferative DR (PDR). The risk of CKD progression was assessed according to DR severity. A total of 384 (24.1%) had NPDR and 202 (12.7%) had PDR at either eye. The mean follow-up period was 5.6±2.1 years. DR was associated with lower body mass index, lower plasma hemoglobin, lower serum albumin level, longer duration of DM, poorer control of blood sugar, lower estimated glomerular filtration rate (eGFR), and greater amount of albuminuria. Interestingly, baseline DR severity was associated with faster renal function decline and greater albuminuria progression. In multivariate analysis, NPDR had 2.9 times and PDR had 16.6 times higher risk for CKD progression. Our findings showed that baseline DR severity is a prognostic factor for future CKD progression in type 2 DM patients. Therefore, clinicians must evaluate DR severity at the first visit and closely monitor renal function and albuminuria in the subjects with severe DR. |
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We screened 2,197 adult patients with type 2 DM who had undergone fundus exam between August 2006 and February 2014. Among them, 1,592 subjects with available serial renal function and albuminuria measurement were included in the analysis. DR status was classified as no DR, non-proliferative DR (NPDR), and proliferative DR (PDR). The risk of CKD progression was assessed according to DR severity. A total of 384 (24.1%) had NPDR and 202 (12.7%) had PDR at either eye. The mean follow-up period was 5.6±2.1 years. DR was associated with lower body mass index, lower plasma hemoglobin, lower serum albumin level, longer duration of DM, poorer control of blood sugar, lower estimated glomerular filtration rate (eGFR), and greater amount of albuminuria. Interestingly, baseline DR severity was associated with faster renal function decline and greater albuminuria progression. In multivariate analysis, NPDR had 2.9 times and PDR had 16.6 times higher risk for CKD progression. Our findings showed that baseline DR severity is a prognostic factor for future CKD progression in type 2 DM patients. Therefore, clinicians must evaluate DR severity at the first visit and closely monitor renal function and albuminuria in the subjects with severe DR.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0220506</identifier><identifier>PMID: 31356653</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Albuminuria - etiology ; Albuminuria - pathology ; Biology and Life Sciences ; Body mass ; Body mass index ; Body size ; Complications ; Development and progression ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - physiopathology ; Diabetic retinopathy ; Diabetic Retinopathy - complications ; Diabetic Retinopathy - epidemiology ; Diabetics ; Disease Progression ; Epidermal growth factor receptors ; Female ; Glomerular Filtration Rate ; Glucose ; Health aspects ; Hemoglobin ; Hospitals ; Humans ; Hypertension ; Incidence ; Internal medicine ; Kidney diseases ; Male ; Medical prognosis ; Medicine ; Medicine and Health Sciences ; Microvasculature ; Middle Aged ; Multivariate analysis ; Nephropathy ; Patients ; Prognosis ; Renal function ; Renal Insufficiency, Chronic - etiology ; Renal Insufficiency, Chronic - pathology ; Retinopathy ; Risk Factors ; Serum albumin ; Sugar ; Time Factors ; Urine</subject><ispartof>PloS one, 2019-07, Vol.14 (7), p.e0220506-e0220506</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Park et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Park et al 2019 Park et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-3de3a3105011200d28ccb3e0305e6802a8ab4b60737b15a7651d55e1f703bf143</citedby><cites>FETCH-LOGICAL-c692t-3de3a3105011200d28ccb3e0305e6802a8ab4b60737b15a7651d55e1f703bf143</cites><orcidid>0000-0002-1128-3750</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2266572088/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2266572088?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31356653$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Wu, Ping-Hsun</contributor><creatorcontrib>Park, Hayne Cho</creatorcontrib><creatorcontrib>Lee, Young-Ki</creatorcontrib><creatorcontrib>Cho, AJin</creatorcontrib><creatorcontrib>Han, Chae Hoon</creatorcontrib><creatorcontrib>Noh, Jung-Woo</creatorcontrib><creatorcontrib>Shin, Young Joo</creatorcontrib><creatorcontrib>Bae, So Hyun</creatorcontrib><creatorcontrib>Kim, Hakyoung</creatorcontrib><title>Diabetic retinopathy is a prognostic factor for progression of chronic kidney disease in the patients with type 2 diabetes mellitus</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Since both retinopathy and nephropathy are major diabetic microvascular complications, we investigated whether severity of diabetic retinopathy (DR) has adverse effects on renal function and albuminuria in the patients with type 2 diabetes mellitus (DM). We screened 2,197 adult patients with type 2 DM who had undergone fundus exam between August 2006 and February 2014. Among them, 1,592 subjects with available serial renal function and albuminuria measurement were included in the analysis. DR status was classified as no DR, non-proliferative DR (NPDR), and proliferative DR (PDR). The risk of CKD progression was assessed according to DR severity. A total of 384 (24.1%) had NPDR and 202 (12.7%) had PDR at either eye. The mean follow-up period was 5.6±2.1 years. DR was associated with lower body mass index, lower plasma hemoglobin, lower serum albumin level, longer duration of DM, poorer control of blood sugar, lower estimated glomerular filtration rate (eGFR), and greater amount of albuminuria. Interestingly, baseline DR severity was associated with faster renal function decline and greater albuminuria progression. In multivariate analysis, NPDR had 2.9 times and PDR had 16.6 times higher risk for CKD progression. Our findings showed that baseline DR severity is a prognostic factor for future CKD progression in type 2 DM patients. Therefore, clinicians must evaluate DR severity at the first visit and closely monitor renal function and albuminuria in the subjects with severe DR.</description><subject>Albuminuria - etiology</subject><subject>Albuminuria - pathology</subject><subject>Biology and Life Sciences</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Complications</subject><subject>Development and progression</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - physiopathology</subject><subject>Diabetic retinopathy</subject><subject>Diabetic Retinopathy - complications</subject><subject>Diabetic Retinopathy - epidemiology</subject><subject>Diabetics</subject><subject>Disease Progression</subject><subject>Epidermal growth factor receptors</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Glucose</subject><subject>Health aspects</subject><subject>Hemoglobin</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Incidence</subject><subject>Internal medicine</subject><subject>Kidney diseases</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Microvasculature</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Nephropathy</subject><subject>Patients</subject><subject>Prognosis</subject><subject>Renal function</subject><subject>Renal Insufficiency, Chronic - etiology</subject><subject>Renal Insufficiency, Chronic - pathology</subject><subject>Retinopathy</subject><subject>Risk Factors</subject><subject>Serum albumin</subject><subject>Sugar</subject><subject>Time Factors</subject><subject>Urine</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNqNk9tu1DAQhiMEoqXwBggsISG42MWH2ElukKpyWqlSJU63luNMNi5ZO7UdYK95cZxuWu2iXqAocTT-5p_MH0-WPSV4SVhB3ly60VvVLwdnYYkpxRyLe9kxqRhdCIrZ_b33o-xRCJcYc1YK8TA7YoRxITg7zv68M6qGaDTy6WndoGK3RSYghQbv1taFaa9VOjqP2nRPUQ8hGGeRa5HuvLOJ-GEaC1vUmAAqADIWxQ5QUjNgY0C_TOxQ3A6AaGKmihDQBvrexDE8zh60qg_wZF5Psm8f3n89-7Q4v_i4Ojs9X2hR0bhgDTDFSOqTEIpxQ0utawaYYQ6ixFSVqs5rgQtW1ISrQnDScA6kLTCrW5Kzk-z5TnfoXZCzf0FSmqwoKC7LRKx2ROPUpRy82Si_lU4ZeR1wfi2VT4b0IEVTaCWEKKqqyite15XAuNSU1GVNNTRJ6-1cbaw30Ojkg1f9gejhjjWdXLufMokyTEkSeDULeHc1QohyY4JOnikLbrz-7gITXnCW0Bf_oHd3N1NrlRowtnWprp5E5Smv8rLMcz5RyzuodDWwMTodttak-EHC64OExET4HddqDEGuvnz-f_bi-yH7co_tQPWxC64fYzp64RDMd6D2LgQP7a3JBMtpVm7ckNOsyHlWUtqz_R90m3QzHOwvrpAPhA</recordid><startdate>20190729</startdate><enddate>20190729</enddate><creator>Park, Hayne Cho</creator><creator>Lee, Young-Ki</creator><creator>Cho, AJin</creator><creator>Han, Chae Hoon</creator><creator>Noh, Jung-Woo</creator><creator>Shin, Young Joo</creator><creator>Bae, So Hyun</creator><creator>Kim, Hakyoung</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-1128-3750</orcidid></search><sort><creationdate>20190729</creationdate><title>Diabetic retinopathy is a prognostic factor for progression of chronic kidney disease in the patients with type 2 diabetes mellitus</title><author>Park, Hayne Cho ; Lee, Young-Ki ; Cho, AJin ; Han, Chae Hoon ; Noh, Jung-Woo ; Shin, Young Joo ; Bae, So Hyun ; Kim, Hakyoung</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-3de3a3105011200d28ccb3e0305e6802a8ab4b60737b15a7651d55e1f703bf143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Albuminuria - etiology</topic><topic>Albuminuria - pathology</topic><topic>Biology and Life Sciences</topic><topic>Body mass</topic><topic>Body mass index</topic><topic>Body size</topic><topic>Complications</topic><topic>Development and progression</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2 - physiopathology</topic><topic>Diabetic retinopathy</topic><topic>Diabetic Retinopathy - complications</topic><topic>Diabetic Retinopathy - epidemiology</topic><topic>Diabetics</topic><topic>Disease Progression</topic><topic>Epidermal growth factor receptors</topic><topic>Female</topic><topic>Glomerular Filtration Rate</topic><topic>Glucose</topic><topic>Health aspects</topic><topic>Hemoglobin</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Incidence</topic><topic>Internal medicine</topic><topic>Kidney diseases</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Microvasculature</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Nephropathy</topic><topic>Patients</topic><topic>Prognosis</topic><topic>Renal function</topic><topic>Renal Insufficiency, Chronic - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Park, Hayne Cho</au><au>Lee, Young-Ki</au><au>Cho, AJin</au><au>Han, Chae Hoon</au><au>Noh, Jung-Woo</au><au>Shin, Young Joo</au><au>Bae, So Hyun</au><au>Kim, Hakyoung</au><au>Wu, Ping-Hsun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diabetic retinopathy is a prognostic factor for progression of chronic kidney disease in the patients with type 2 diabetes mellitus</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-07-29</date><risdate>2019</risdate><volume>14</volume><issue>7</issue><spage>e0220506</spage><epage>e0220506</epage><pages>e0220506-e0220506</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Since both retinopathy and nephropathy are major diabetic microvascular complications, we investigated whether severity of diabetic retinopathy (DR) has adverse effects on renal function and albuminuria in the patients with type 2 diabetes mellitus (DM). We screened 2,197 adult patients with type 2 DM who had undergone fundus exam between August 2006 and February 2014. Among them, 1,592 subjects with available serial renal function and albuminuria measurement were included in the analysis. DR status was classified as no DR, non-proliferative DR (NPDR), and proliferative DR (PDR). The risk of CKD progression was assessed according to DR severity. A total of 384 (24.1%) had NPDR and 202 (12.7%) had PDR at either eye. The mean follow-up period was 5.6±2.1 years. DR was associated with lower body mass index, lower plasma hemoglobin, lower serum albumin level, longer duration of DM, poorer control of blood sugar, lower estimated glomerular filtration rate (eGFR), and greater amount of albuminuria. Interestingly, baseline DR severity was associated with faster renal function decline and greater albuminuria progression. In multivariate analysis, NPDR had 2.9 times and PDR had 16.6 times higher risk for CKD progression. Our findings showed that baseline DR severity is a prognostic factor for future CKD progression in type 2 DM patients. Therefore, clinicians must evaluate DR severity at the first visit and closely monitor renal function and albuminuria in the subjects with severe DR.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31356653</pmid><doi>10.1371/journal.pone.0220506</doi><tpages>e0220506</tpages><orcidid>https://orcid.org/0000-0002-1128-3750</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Albuminuria - etiology Albuminuria - pathology Biology and Life Sciences Body mass Body mass index Body size Complications Development and progression Diabetes Diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - physiopathology Diabetic retinopathy Diabetic Retinopathy - complications Diabetic Retinopathy - epidemiology Diabetics Disease Progression Epidermal growth factor receptors Female Glomerular Filtration Rate Glucose Health aspects Hemoglobin Hospitals Humans Hypertension Incidence Internal medicine Kidney diseases Male Medical prognosis Medicine Medicine and Health Sciences Microvasculature Middle Aged Multivariate analysis Nephropathy Patients Prognosis Renal function Renal Insufficiency, Chronic - etiology Renal Insufficiency, Chronic - pathology Retinopathy Risk Factors Serum albumin Sugar Time Factors Urine |
title | Diabetic retinopathy is a prognostic factor for progression of chronic kidney disease in the patients with type 2 diabetes mellitus |
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