title: Interactive effect of retinopathy and macroalbuminuria on all-cause mortality, cardiovascular and renal end points in Chinese patients with Type 2 diabetes mellitus.
abstract: OBJECTIVE
  To examine the effect of albuminuria and retinopathy on the risk of cardiovascular and renal events, and all-cause mortality in patients with Type 2 diabetes.
  
  
  METHODS
  A post-hoc analysis of 4416 Chinese patients without macrovascular complications at baseline (age 57.6 +/- 13.3 years). Glomerular filtration rate (eGFR) was estimated by the abbreviated Modification of Diet in Renal Disease Study Group Formula, further adjusted for Chinese ethnicity. Clinical end points were all-cause mortality, cardiovascular events (heart failure or angina, myocardial infarction, lower limb amputation, re-vascularization procedures and stroke) and renal end points (reduction in eGFR by more than 50% or eGFR < 15 ml/min/1.73 m2 or death as a result of renal causes or need for dialysis).
  
  
  RESULTS
  Compared with individuals without complications, subjects with retinopathy and macroalbuminuria had higher rates of cardiovascular events (14.1 vs. 2.4%), renal events (40.0 vs. 0.8%) and death (9.3 vs. 1.7%, P < 0.001). For composite event of death, cardiovascular and renal events, the presence of retinopathy, microalbuminuria alone, macroalbuminuria alone, retinopathy with microalbuminuria or retinopathy with macroalbuminuria increased the risk [hazard ratio (95% CI)] by 1.61 (1.05 to 2.47; P = 0.04), 1.93 (1.38 to 2.69; P < 0.001), 4.34 (3.02 to 6.22; P < 0.001), 2.59 [1.76 to 3.81; P < 0.001) and 6.83 (4.89 to 9.55; P < 0.001) fold, respectively. The relative excess risk as a result of interaction between retinopathy and macroalbuminuria was 15.31, implying biological interaction in the development of renal events.
  
  
  CONCLUSIONS
  In Chinese patients with Type 2 diabetes, retinopathy interacts with macroalbuminuria to increase the risk of composite cardio-renal events.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, NT, Hong Kong. ptong@cuhk.edu.hk
authors.forename: P C Y
authors.initials: PC
authors.lastname: Tong
authors.forename: A P
authors.initials: AP
authors.lastname: Kong
authors.forename: W Y
authors.initials: WY
authors.lastname: So
authors.forename: X
authors.initials: X
authors.lastname: Yang
authors.forename: M C Y
authors.initials: MC
authors.lastname: Ng
authors.forename: C S
authors.initials: CS
authors.lastname: Ho
authors.forename: R C W
authors.initials: RC
authors.lastname: Ma
authors.forename: R
authors.initials: R
authors.lastname: Ozaki
authors.forename: V
authors.initials: V
authors.lastname: Ng
authors.forename: C C
authors.initials: CC
authors.lastname: Chow
authors.forename: C W K
authors.initials: CW
authors.lastname: Lam
authors.forename: J C N
authors.initials: JC
authors.lastname: Chan
authors.forename: C S
authors.initials: CS
authors.lastname: Cockram
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000150:complications*; D044466:Asian People; D015415:Biomarkers / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000150:complications / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000150:complications* / Q000401:mortality; D003930:Diabetic Retinopathy / Q000150:complications*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D015415:Biomarkers