Publicaciones científicas
The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes
Sheila Bermejo 1 2 3 , Ester González 4 , Katia López-Revuelta 5 , Meritxell Ibernon 6 , Diana López 7 , Adoración Martín-Gómez 8 , Rosa Garcia-Osuna 9 , Tania Linares 10 , Montserrat Díaz 11 , Nàdia Martín 12 , Xoana Barros 12 , Helena Marco 11 13 , Maruja Isabel Navarro 13 , Noemí Esparza 14 , Sandra Elias 15 , Ana Coloma 16 17 , Nicolás Roberto Robles 18 , Irene Agraz 1 2 , Esteban Poch 19 20 , Lida Rodas 19 20 , Víctor Lozano 19 20 , Beatriz Fernández-Fernández 21 , Eduardo Hernández 4 , Maria Isabel Martínez 5 , Ramona Ionela Stanescu 5 , José Pelayo Moirón 7 , Núria García-Fernández 7 , Marian Goicoechea 10 , Francesca Calero 11 , Josep Bonet 13 , Fernando Liaño 22 , Julio Pascual 3 , Oriol Bestard 1 2 , Manuel Praga 4 , Xavier Fulladosa 17 , María José Soler 1 2 3
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.
CITA DEL ARTÍCULO Clin Kidney J. 2023 Jul 6;16(10):1656-1663. doi: 10.1093/ckj/sfad142. eCollection 2023 Oct
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