Retinal vessel diameters and the incidence of gross proteinuria and renal insufficiency in people with type 1 diabetes.
Early retinal vessel caliber changes may predict risk of diabetic nephropathy. We examined the association of retinal vessel diameters and the incidence of gross proteinuria and renal insufficiency in a population-based cohort of people with type 1 diabetes (n = 557). Baseline retinal photographs were digitized, and diameters of individual retinal vessels were measured and summarized. Incident cases of gross proteinuria and renal insufficiency were identified over a 16-year period. Larger retinal venular diameter was associated with higher cumulative incidence of gross proteinuria (18.6, 25.4, 37.7, and 50.4%, comparing increasing venular diameter quartiles) and renal insufficiency (10.7, 15.5, 23.2, and 32.8%). After adjusting for age, sex, duration of diabetes, HbA(1c) levels, baseline retinopathy levels, and other factors, larger retinal venular diameter was associated with an increased risk of gross proteinuria (RR 1.53, 95% CI 1.19-1.97, comparing 4th vs. 1st to 3rd quartiles of venular diameter) and renal insufficiency (1.51, 1.05-2.17). Retinal arteriolar diameter was not associated with either gross proteinuria or renal insufficiency. We conclude that in individuals with type 1 diabetes, larger retinal venular diameter is independently associated with the long-term incidence of gross proteinuria and renal insufficiency and may provide additional predictive information regarding risk of nephropathy.
Wong
Tien Yin
TY
Centre for Vision Research, University of Melbourne, Melbourne, Australia. ophwty@nus.edu.au
Shankar
Anoop
A
Klein
Ronald
R
Klein
Barbara E K
BE
D000328:Adult; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000453:epidemiology*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012171:Retinal Vessels / Q000473:pathology*; D012307:Risk Factors; D012907:Smoking; D014699:Venules / Q000473:pathology
D008076:Cholesterol, HDL; D002784:Cholesterol