title: Ischemic diabetic retinopathy as a possible prognostic factor for chronic kidney disease progression.
abstract: OBJECTIVE
  To assess the value of diabetic retinopathy (DR) severity as a possible predictive prognostic factor for the progression of chronic kidney disease (CKD).
  
  
  METHODS
  Retrospective cohort study. Patients (51) who were initially diagnosed with DR and CKD were enrolled and their medical records were evaluated. The following ophthalmic factors were assessed by fluorescein angiography at the initial visit: area of capillary nonperfusion, presence of neovascularization and vitreous hemorrhage, and DR grade. The effect of these factors on CKD progression over the 2-year period of the study, defined as doubling of serum creatinine or the development of end-stage renal disease requiring dialysis or renal transplant, was evaluated.
  
  
  RESULTS
  The study included 51 patients with DR and CKD; of these, 11 patients (21.6%) were found to have proliferative DR (PDR) and seven patients (13.7%) had high-risk PDR at baseline. Patients with ischemic DR, who showed extensive capillary nonperfusion (≥ 10 optic disc areas) in the retina, had a greater risk for CKD progression (hazard ratio = 6.64; P = 0.002).
  
  
  CONCLUSIONS
  We found that extensive capillary nonperfusion in the retina greatly increased the risk of progression of CKD in patients with DR. This suggests that the retina and the kidney may have shared risk factors for microvascular disease secondary to diabetes mellitus, and emphasizes the need for a team approach to diabetes care.
authors.affiliation: Department of Ophthalmology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri-City, South Korea.
authors.forename: W J
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Uveitis and Retina Services, Boston, MA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Sobrin
authors.affiliation: Department of Ophthalmology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri-City, South Korea.
authors.forename: M H
authors.initials: MH
authors.lastname: Kang
authors.affiliation: Department of Ophthalmology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri-City, South Korea.
authors.forename: M
authors.initials: M
authors.lastname: Seong
authors.affiliation: Department of Ophthalmology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri-City, South Korea.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Nephrology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri-City, South Korea.
authors.forename: J-H
authors.initials: JH
authors.lastname: Yi
authors.affiliation: Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Uveitis and Retina Services, Boston, MA, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Miller
authors.affiliation: 1] Department of Ophthalmology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri-City, South Korea [2] Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Uveitis and Retina Services, Boston, MA, USA.
authors.forename: H Y
authors.initials: HY
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005451:Fluorescein Angiography; D005919:Glomerular Filtration Rate; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000175:diagnosis; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000503:physiopathology; D015861:Retinal Neovascularization / Q000175:diagnosis; D012171:Retinal Vessels / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D014823:Vitreous Hemorrhage / Q000175:diagnosis
chemical_list: D003404:Creatinine