• DR and Diabetic Kidney Disease Are Risk Factors for Mortality

    By Lynda Seminara
    Selected By: Deepak P. Edward, MD

    Journal Highlights

    JAMA Network Open
    2019;2(3):e191540

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    Sabanayagam et al. assessed the rela­tionship between diabetic retinopathy (DR), diabetic kidney disease (DKD), and mortality in a large Asian popula­tion. They found that the presence of either condition is linked to higher risk of all-cause and cardiovascular-related mortality and that the risk is greater with DKD.

    For this study, the researchers eval­uated 2,964 adults with diabetes who participated in the Singapore Epide­miology of Eye Diseases study. Partici­pants ranged from 40 to 80 years of age (mean, 61.8 years) and were Chinese (n = 592), Malay (n = 1,052), or Indian (n = 1,320). DR was identified from retinal photographs, and DKD was established from estimated glomerular filtration rates; these analyses revealed that 30% of the study population had DR, and 21% had DKD. Data for all-cause and cardiovascular disease (CVD) mortality were gathered from the National Registry of Births and Deaths.

    During the median follow-up period of 8.8 years (range, 7.2-11.0 years), 610 deaths occurred (20.6% of the study population). Of these, 267 deaths were attributed to CVD. In separate models for all-cause and CVD mortality, mul­tivariable hazard ratios were 1.54 and 1.74, respectively, for DR; and 2.04 and 2.29, respectively, for DKD. In models that included both DR and DKD, the subgroup with DKD alone contributed strongly to the excess risk of all-cause and CVD mortality (27.1% and 12.6%, respectively), followed by the subgroup with DR alone (6.5% and 5.2%). Com­pared with patients who had neither DR nor DKD, the hazard ratios for all-cause and CVD mortality were 1.89 and 2.26, respectively, for DKD alone and 1.38 and 1.64, respectively, for DR alone. For patients with DR as well as DKD, the respective hazard ratios were 2.76 and 3.41. The relative excess risk of the DR/DKD interaction was 0.49 (p = .20) for all-cause mortality and 0.51 (p = .50) for CVD mortality.

    The authors concluded that the risk of all-cause and CVD mortality is high for patients with DKD and/or DR, and that DKD confers a greater risk than DR. Their findings highlight the importance of early identification, close monitoring, and proper management of these conditions to reduce the risk of death, particularly in Asian popula­tions.

    The original article can be found here.