title: Is chronic kidney disease associated with diabetic retinopathy in Asian adults?
abstract: BACKGROUND
  Diabetic nephropathy (DN) is commonly associated with diabetic retinopathy (DR). Few studies have demonstrated that chronic kidney disease (CKD) is associated with DR. However, it is not clear if CKD in the absence of albuminuria is associated with DR.
  
  
  METHODS
  We included 301 participants with diabetes (Chinese, Malay and Indian ethnicity aged ≥24 years who participated in the Singapore Prospective Study Program (2003-2007). Retinal photographs taken from both eyes were graded for DR using the modified Airlie House Classification. We examined the association of CKD defined by low estimated glomerular filtration rate (eGFR) (<60 mL/min per 1.73 m(2) , n = 54), and albuminuria (urinary albumin-to-creatinine ratio ≥30, n = 116) with any-DR (n = 99) in logistic regression models. We replicated this analysis in another independent population-based sample of Malay adults (n = 265) with similar methodology in Singapore.
  
  
  RESULTS
  41% of those with low-eGFR had normoalbuminuria. In separate models, while albuminuria was significantly associated with any-DR, low-eGFR was not significantly associated with any-DR. In a model combining both markers, compared to the referent group (normal-eGFR+normoalbuminuria), the odds ratio (OR) (95% confidence interval [CI]) of any-DR were: 2.33 (1.27-4.27) for normal-eGFR+albuminuria, 1.38 (0.49-3.91) for low-eGFR + normoalbuminuria, and 2.64 (1.05-6.63) for low-eGFR+albuminuria. Similar findings for any-DR were observed in the replication cohort of Malay persons (3.56 [1.49-8.54] for normal-eGFR+albuminuria, 1.69 (0.52-5.55) for low-eGFR+normoalbuminuria, 4.34 [1.68-11.24] for low-eGFR+albuminuria.
  
  
  CONCLUSIONS
  We demonstrated that CKD is associated with DR only in the presence of albuminuria suggesting that CKD is more likely related to diabetes in the presence of albuminuria.
authors.affiliation: Singapore Eye Research Institute, Singapore; Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore; Department of Ophthalmology, National University of Singapore, Singapore.
authors.forename: Charumathi
authors.initials: C
authors.lastname: Sabanayagam
authors.forename: Valencia Hui Xian
authors.initials: VH
authors.lastname: Foo
authors.forename: M Kamran
authors.initials: MK
authors.lastname: Ikram
authors.forename: Huiqi
authors.initials: H
authors.lastname: Huang
authors.forename: Su Chi
authors.initials: SC
authors.lastname: Lim
authors.forename: Ecosse L
authors.initials: EL
authors.lastname: Lamoureux
authors.forename: E Shyong
authors.initials: ES
authors.lastname: Tai
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
mesh_terms: D000328:Adult; D044466:Asian People; D003430:Cross-Sectional Studies; D003928:Diabetic Nephropathies / Q000150:complications*; D003930:Diabetic Retinopathy / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D055815:Young Adult
keywords: albuminuria; diabetic retinopathy; estimated glomerular filtration rate; 关键词：蛋白尿，糖尿病视网膜病变，估算的肾小球滤过率