DIABETIC RETINOPATHY IS A POSSIBLE PROGNOSTIC FACTOR FOR CHRONIC KIDNEY DISEASE PROGRESSION?

To evaluate the determinants of concordance between diabetic retinopathy (DR) and chronic kidney disease (CKD), assessed by estimated glomerular filtration rate (eGFR) and hemoglobin A1c(HbA1c), in an observational prospective study.100 patients with type 1(T1DM) and 2 diabetes(T2DM) (53% male, 47% female) visiting Nefrology Departament at INDNBN Paulescu, Bucharest, in years 2013 and 2015 were examined. DR was assessed by dilated fundoscopy. CKD was defined based on albuminuria,serum creatinine, urinary albumine creatinine ratio- UACR and eGFR.CKD was present in 67% of subjects with DR (19% nonproliferative diabetic retinopahty-NPDR), whereas advanced PDR (proliferative diabetic retinopathy) was detectable in 48% of individuals with any CKD. Age (60,79 +/- 14,46years), male sex, diabetes duration (17,08 +/- 8,35 years), hemoglobin A1c-HbA1c (7,92 +/- 1,8%.), hypertension(52%), triglycerides, previous cardiovascular disease, and, inversely, HDL-cholesterol correlated independently with the presence of any CKD in individuals with advanced DR; correlates differed according to the presence of albuminuria, reduced eGFR, or both. Conversely, factors associated with the presence of advanced DR in subjects with any CKD were diabetes treatment, previous cardiovascular disease, albuminuria, and, inversely,- eGFR, and age at diagnosis.DR is directly correlated with CKD stages. Concordance of CKD with advanced DR is low in subjects with type 2 diabetes. CKD without advanced DR is more frequent than isolated advanced DR, at variance with type 1 diabetes(rho=-0,25, p=0,000). 67% of patients with renal impairement have DR,48% beeing in proliferative stages corresponding to a lowerig of eGFR. The decrease of HbA1c% values with the progression of CKD reveal the metabolic impairement cost by the presence of multiple hypoglycemic episodes, reason why we recomanded the use of continuous glucose monitoring (CGM) as a reliable method to determine the metabolic impairement this kind of patients.