title: Diabetic retinopathy in predicting diabetic nephropathy in patients with type 2 diabetes and renal disease: a meta-analysis.
abstract: OBJECTIVE
  The aim of this meta-analysis is to determine the predictive value of diabetic retinopathy in differentiating diabetic nephropathy from non-diabetic renal diseases in patients with type 2 diabetes and renal disease.
  
  
  METHODS
  Medline and Embase databases were searched from inception to February 2012. Renal biopsy studies of participants with type 2 diabetes were included if they contained data with measurements of diabetic retinopathy. Pooled sensitivity, specificity, positive predictive value, negative predictive value and other diagnostic indices were evaluated using a random-effects model.
  
  
  RESULTS
  The meta-analysis investigated 26 papers with 2012 patients. The pooled sensitivity and specificity of diabetic retinopathy to predict diabetic nephropathy were 0.65 (95% CI 0.62, 0.68) and 0.75 (95% CI 0.73, 0.78), respectively. The pooled positive and negative predictive value of diabetic retinopathy to predict diabetic nephropathy were 0.72 (95% CI 0.68, 0.75) and 0.69 (95% CI 0.67, 0.72), respectively. The area under the summary receiver operating characteristic curve was 0.75, and the diagnostic odds ratio was 5.67 (95% CI 3.45, 9.34). For proliferative diabetic retinopathy, the pooled sensitivity was 0.25 (95% CI 0.16, 0.35), while the specificity was 0.98 (95% CI 0.92, 1.00). There was heterogeneity among studies (p < 0.001), and no publishing bias was identified.
  
  
  CONCLUSIONS
  Diabetic retinopathy is useful in diagnosing or screening for diabetic nephropathy in patients with type 2 diabetes and renal disease. Proliferative diabetic retinopathy may be a highly specific indicator for diabetic nephropathy.
authors.affiliation: Department of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, Zhongshan Road II, Guangzhou 510080, China.
authors.forename: F
authors.initials: F
authors.lastname: He
authors.forename: X
authors.initials: X
authors.lastname: Xia
authors.forename: X F
authors.initials: XF
authors.lastname: Wu
authors.forename: X Q
authors.initials: XQ
authors.lastname: Yu
authors.forename: F X
authors.initials: FX
authors.lastname: Huang
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000175:diagnosis* / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000453:epidemiology*