title: Retinopathy and clinical outcomes in patients with type 2 diabetes mellitus, chronic kidney disease, and anemia.
abstract: OBJECTIVE
  Retinopathy is an established microvascular complication of type 2 diabetes mellitus (T2DM), but its independent relationship with macrovascular and other microvascular complications is less well defined across the spectrum of kidney disease in T2DM. We examined the prognostic value of retinopathy in assessing the risk of developing end-stage renal disease (ESRD), cardiovascular morbidity or death among patients in the Trial to Reduce cardiovascular Events with Aranesp Therapy (TREAT).
  
  
  METHODS
  TREAT enrolled 4038 patients with T2DM, chronic kidney disease (CKD) and moderate anemia. Patients were grouped by baseline history of retinopathy. Proportional hazards regression models were utilized to assess the association between retinopathy and subsequent ESRD, cardiovascular morbidity or death over an average of 2.4 years.
  
  
  RESULTS
  Although younger, the 1895 (47%) patients with retinopathy had longer duration of diabetes, lower estimated glomerular filtration rate, more proteinuria, and more microvascular complications. In univariate analysis, retinopathy was associated with a higher rate of ESRD, but not with cardiovascular events or mortality. After adjustment, retinopathy was no longer statistically significant for the prediction of ESRD or any clinical endpoint.
  
  
  CONCLUSIONS
  In a large cohort of patients with T2DM, CKD, and anemia, retinopathy was common but not independently associated with a higher risk of renal or cardiovascular morbidity or death.
  
  
  BACKGROUND
  NCT00093015.
authors.affiliation: Cardiovascular Division , Brigham and Women's Hospital , Boston, Massachusetts , USA.
authors.forename: Natalie A
authors.initials: NA
authors.lastname: Bello
authors.affiliation: Cardiovascular Division , Brigham and Women's Hospital , Boston, Massachusetts , USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.affiliation: Cardiovascular Division , Brigham and Women's Hospital , Boston, Massachusetts , USA.
authors.forename: Hicham
authors.initials: H
authors.lastname: Skali
authors.affiliation: Division of Endocrinology, Metabolism, and Lipid Research , Washington University School of Medicine , St. Louis, Missouri , USA.
authors.forename: Janet B
authors.initials: JB
authors.lastname: McGill
authors.affiliation: Amgen , Thousand Oaks, California , USA.
authors.forename: Jerome
authors.initials: J
authors.lastname: Rossert
authors.affiliation: Amgen , Thousand Oaks, California , USA.
authors.forename: Kurt A
authors.initials: KA
authors.lastname: Olson
authors.affiliation: Cardiovascular Division , Brigham and Women's Hospital , Boston, Massachusetts , USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Weinrauch
authors.affiliation: Baker IDI Heart & Diabetes Institute , Melbourne, Victoria , Australia.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Cooper
authors.affiliation: Department of Clinical Pharmacology , University of Groningen, University Medical Center Groningen , The Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: de Zeeuw
authors.affiliation: Steno Diabetes Center , Copenhagen , Denmark ; Health , University of Aarhus , Denmark ; CBMR, University of Copenhagen , Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Rossing
authors.affiliation: BHF Glasgow Cardiovascular Research Centre , University of Glasgow , Glasgow , UK.
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.affiliation: Cardiovascular Division , Brigham and Women's Hospital , Boston, Massachusetts , USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
keywords: Cardiovascular Outcomes; Chronic Kidney Disease; Retinopathy; Type 2 Diabetes