title: The Association of Estimated Glomerular Filtration Rate With Diabetic Retinopathy and Macular Edema.
abstract: OBJECTIVE
  Albuminuria, a marker of diabetic kidney disease, is closely associated with diabetic retinopathy (DR) and diabetic macular edema (DME). However, the relationship between estimated glomerular filtration rate (eGFR) with DR and DME remains unclear, particularly in type 2 diabetes. We investigated the association of eGFR with DR and DME in a sample of patients with type 2 diabetes.
  
  
  METHODS
  We included 263 Caucasian patients with type 2 diabetes aged ≥ 18 years who participated in a clinic-based cross-sectional study in Melbourne, Australia. Diabetic retinopathy (n = 140) and DME (n = 61) were assessed from retinal photographs graded using the modified Airlie House classification and further confirmed with optical coherence tomography. Estimated glomerular filtration rate, assessed using the CKD-EPI formula, was analyzed continuously (per SD change) and categorically (normal renal function ≥ 90; impaired renal function, 60-89, and chronic kidney disease [CKD] < 60 mL/min/1.73 m2).
  
  
  RESULTS
  When eGFR was analyzed categorically, impaired renal function and CKD were associated with the presence of DR when compared to normal renal function in multivariable models (odds ratio [OR] with 95% confidence interval [CI] of 2.97 [1.12-7.87] and 3.77 [1.28-11.10]), respectively. In DR severity analyses, CKD showed significant associations with moderate (5.83 [1.44-23.5], P-trend = 0.02) and severe DR (4.91 [1.26-19.0], P-trend = 0.04). These associations persisted when eGFR was analyzed continuously (P = 0.04). No significant associations were found between eGFR and DME.
  
  
  CONCLUSIONS
  Our results suggest that lower levels of eGFR were associated with the presence and severity of DR, but not with DME.
authors.affiliation: Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia 2Singapore Eye Research Institute, National University of Singapore, Singapore.
authors.forename: Ryan Eyn Kidd
authors.initials: RE
authors.lastname: Man
authors.affiliation: Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia 3Department of Ophthalmology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
authors.forename: Muhammad Bayu
authors.initials: MB
authors.lastname: Sasongko
authors.affiliation: Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia 4Centre for Vision Research, Westmead Millenium Institute, University of Sydney, Sydney, Australia.
authors.forename: Jie Jin
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Department of Endocrinology and Diabetes, St. Vincent's Hospital and University of Melbourne, Melbourne, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: MacIsaac
authors.affiliation: Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia 2Singapore Eye Research Institute, National University of Singapore, Singapore 6Duke-NUS Graduate Medical School, Singapore.
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
authors.affiliation: Singapore Eye Research Institute, National University of Singapore, Singapore 6Duke-NUS Graduate Medical School, Singapore.
authors.forename: Charumathi
authors.initials: C
authors.lastname: Sabanayagam
authors.affiliation: Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia 2Singapore Eye Research Institute, National University of Singapore, Singapore 6Duke-NUS Graduate Medical School, Singapore.
authors.forename: Ecosse L
authors.initials: EL
authors.lastname: Lamoureux
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008269:Macular Edema / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D041623:Tomography, Optical Coherence / Q000379:methods; D014739:Victoria / Q000453:epidemiology