title: Diabetes retinopathy is a poor predictor for renal and cardiovascular outcomes in comparison with hypertensive retinopathy in patients with chronic kidney disease.
abstract: OBJECTIVE
  Chronic kidney disease (CKD) and retinopathy share the common pathophysiology of microvascular dysfunction. It is unclear whether the clinical significance of diabetic retinopathy (DMR) and hypertensive retinopathy (HTNR) differs in CKD patients.
  
  
  METHODS
  We included 684 nondialysis-dependent CKD stage 3-5 patients with diabetes or hypertension: 501 patients with diabetes and 183 with hypertension. The clinical significance of DMR and HTNR was evaluated in terms of the rate of renal function decline and composite of any cardiovascular event or death.
  
  
  RESULTS
  DMR was observed in 261 (52.1%) CKD patients with diabetes, and HTNR in 44 (24.0%) CKD patients with hypertension. In the diabetes group, the renal function decline rate was significantly steeper in patients with than in those without DMR (-7.4 ± 9.8mL/min/1.73m(2)/yr vs. -2.4 ± 7.6mL/min/1.73m(2)/yr; P<0.001). In multivariate analysis, DMR were independently associated with a rapid decline in renal function (β=-2.44; P=0.20). However, HTNR did not affect the renal function decline in CKD patients. The composite event-free survival rate was lower in patients with diabetes and DMR than in those without DMR (P=0.043). Patients with diabetes and DMR were independently associated with a 2.13-fold increased risk for composite events (P=0.010). HTNR was not associated with higher risk for composite events in CKD patients.
  
  
  CONCLUSIONS
  Coexistence of diabetes and DMR were independently associated with CKD progression and composite cardiovascular event/death, but the clinical significance of HTNR is less clear in CKD patients.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Internal Medicine, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea.
authors.forename: Hyeon Seok
authors.initials: HS
authors.lastname: Hwang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Internal Medicine, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea.
authors.forename: Yoo A
authors.initials: YA
authors.lastname: Choi
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Internal Medicine, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea.
authors.forename: Se Young
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Won-Kyung
authors.initials: WK
authors.lastname: Cho
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Internal Medicine, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea.
authors.forename: Yunju
authors.initials: Y
authors.lastname: Nam
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea.
authors.forename: Sung Jun
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea. Electronic address: berrynana@catholic.ac.kr.
authors.forename: Hye Eun
authors.initials: HE
authors.lastname: Yoon
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Internal Medicine, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea.
authors.forename: Yoon Kyung
authors.initials: YK
authors.lastname: Chang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea.
authors.forename: Seok Joon
authors.initials: SJ
authors.lastname: Shin
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Chul Woo
authors.initials: CW
authors.lastname: Yang
authors.affiliation: Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Internal Medicine, Daejeon St. Mary's Hospital, Daejeon, Republic of Korea.
authors.forename: Suk Young
authors.initials: SY
authors.lastname: Kim
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications* / Q000401:mortality; D003930:Diabetic Retinopathy / Q000150:complications*; D018450:Disease Progression; D005260:Female; D006801:Humans; D058437:Hypertensive Retinopathy / Q000150:complications*; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality; D056910:Republic of Korea / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends
keywords: Cardiovascular event; Chronic kidney disease; Diabetes; Mortality; Retinopathy