title: Rate and determinants of association between advanced retinopathy and chronic kidney disease in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian multicenter study.
abstract: OBJECTIVE
  To evaluate the rate and determinants of concordance between advanced diabetic retinopathy (DR) and chronic kidney disease (CKD), as assessed by both albuminuria and estimated glomerular filtration rate (eGFR), in the large cohort of the Renal Insufficiency And Cardiovascular Events (RIACE) Italian multicenter study.
  
  
  METHODS
  Patients with type 2 diabetes (n = 15,773) visiting consecutively 19 hospital-based diabetes clinics in years 2007 and 2008 were examined. DR was assessed by dilated fundoscopy. CKD was defined based on albuminuria and eGFR.
  
  
  RESULTS
  CKD was present in 58.64% of subjects with advanced DR, whereas advanced DR was detectable only in 15.28% of individuals with any CKD and correlated with the albuminuric CKD phenotypes more than with the nonalbuminuric phenotype. Age, male sex, diabetes duration, hemoglobin A(1c), hypertension, triglycerides, previous cardiovascular disease, and, inversely, HDL-cholesterol correlated independently with the presence of any CKD in individuals with advanced DR; correlates differed according to the presence of albuminuria, reduced eGFR, or both. Conversely, factors associated with the presence of advanced DR in subjects with any CKD were diabetes treatment, previous cardiovascular disease, albuminuria, and, inversely, smoking, eGFR, and age at diagnosis.
  
  
  CONCLUSIONS
  Concordance of CKD with advanced DR is low in subjects with type 2 diabetes, and CKD without advanced DR is more frequent than isolated advanced DR, at variance with type 1 diabetes. Factors independently associated with the presence of any CKD in individuals with advanced DR differ, at least in part, from those correlating with the presence of advanced DR in subjects with any CKD and by CKD phenotype.
authors.affiliation: Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Penno
authors.forename: Anna
authors.initials: A
authors.lastname: Solini
authors.forename: Giacomo
authors.initials: G
authors.lastname: Zoppini
authors.forename: Emanuela
authors.initials: E
authors.lastname: Orsi
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Zerbini
authors.forename: Roberto
authors.initials: R
authors.lastname: Trevisan
authors.forename: Gabriella
authors.initials: G
authors.lastname: Gruden
authors.forename: Franco
authors.initials: F
authors.lastname: Cavalot
authors.forename: Luigi
authors.initials: L
authors.lastname: Laviola
authors.forename: Susanna
authors.initials: S
authors.lastname: Morano
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pugliese
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000209:etiology; D003930:Diabetic Retinopathy / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology