title: More impact of microalbuminuria on retinopathy than moderately reduced GFR among type 2 diabetic patients.
abstract: OBJECTIVE
  The current study aimed to investigate whether microalbuminuria or moderately decreased glomerular filtration rate (GFR) is a better predictor for the development and progression of retinopathy in type 2 diabetic patients.
  
  
  METHODS
  Type 2 diabetic patients without cardiovascular diseases, malignancy, pregnancy, and acute intercurrent illness were enrolled between 1 August 2001 and 31 December 2002. All participants provided their detailed medical history and underwent an eye fundus examination. They were followed up in outpatient clinics, and serum creatinine, urinary albumin-to-creatinine ratio (UACR), and retinal photographs were followed up annually until 31 December 2009. The primary outcomes were development and progression of diabetic retinopathy and nephropathy. The secondary outcomes were cardiovascular events and all-cause mortality.
  
  
  RESULTS
  Among 487 participants, 81 subjects had normoalbuminuria and moderate renal impairment (baseline eGFR 30-59.9 mL/min/1.73 m(2)), and 106 subjects had microalbuminuria and baseline eGFR ≥60 mL/min/1.73 m(2). Patients with microalbuminuria and eGFR ≥60 mL/min/1.73 m(2) had a significantly greater risk for development and progression of diabetic retinopathy (HR 3.34 [95% CI 1.04-10.70]) compared with those with moderate renal impairment and normoalbuminuria after multivariate adjustment. Risks for renal outcome, cardiovascular events, and all-cause mortality were not significantly different between the two groups.
  
  
  CONCLUSIONS
  Microalbuminuria has a greater impact on predicting the development and progression of diabetic retinopathy compared with moderate decline in GFR among type 2 diabetic patients.
authors.affiliation: Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yu-Hsin
authors.initials: YH
authors.lastname: Chen
authors.forename: Harn-Shen
authors.initials: HS
authors.lastname: Chen
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Tarng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000150:complications* / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000150:complications* / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011247:Pregnancy