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Original research
Retinopathy progression and the risk of end-stage kidney disease: results from a longitudinal Japanese cohort of 232 patients with type 2 diabetes and biopsy-proven diabetic kidney disease
  1. Masayuki Yamanouchi1,2,3,4,
  2. Mikiro Mori5,
  3. Junichi Hoshino1,4,
  4. Keiichi Kinowaki6,
  5. Takeshi Fujii6,
  6. Kenichi Ohashi7,
  7. Kengo Furuichi8,
  8. Takashi Wada3,9,
  9. Yoshifumi Ubara1,2,4
  1. 1 Nephrology Center, Toranomon Hospital, Tokyo, Japan
  2. 2 Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan
  3. 3 Department of Nephrology and Laboratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
  4. 4 Okinaka Memorial Institute for Medical Research, Tokyo, Japan
  5. 5 Department of Ophthalmology, Toranomon Hospital, Tokyo, Japan
  6. 6 Department of Pathology, Toranomon Hospital, Tokyo, Japan
  7. 7 Department of Pathology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
  8. 8 Department of Nephrology, School of Medicine, Kanazawa Medical University, Ishikawa, Japan
  9. 9 Division of Nephrology, Kanazawa University Hospital, Ishikawa, Japan
  1. Correspondence to Dr Masayuki Yamanouchi; m.yamanouchi{at}


Objective The predictive value of diabetic retinopathy on end-stage kidney disease (ESKD) has not been fully addressed in patients with type 2 diabetes and diabetic kidney disease.

Research design and methods We studied 232 patients with type 2 diabetes and biopsy-proven diabetic kidney disease who were screened for diabetic retinopathy during the 1 month of kidney biopsy. We examined the association between retinopathy progression and renal lesions. We used Cox regression analyses to explore the risk of ESKD adjusting for known risk demographic and clinical variables. We assessed the incremental prognostic value of ESKD by adding diabetic retinopathy to the clinical variables.

Results The diabetic retinopathy progression positively correlated with all scores of renal lesions, especially with the glomerular-based classification (r=0.41), scores of interstitial fibrosis (r=0.41) and diffuse lesion (r=0.48). During a median follow-up of 5.7 years, 114 patients developed ESKD. Adjusting for known risk factors of ESKD, the HR for ESKD (patients with no apparent retinopathy as a reference) were 1.96 (95% CI 0.62 to 6.17) for patients with mild non-proliferative diabetic retinopathy (NPDR), 3.10 (95% CI 1.45 to 6.65) for patients with moderate NPDR, 3.03 (95% CI 1.44 to 6.37) for patients with severe NPDR, and 3.43 (95% CI 1.68 to 7.03) for patients with proliferative diabetic retinopathy, respectively. Addition of the retinopathy grading to the clinical model alone improved the prognostic value (the global χ2 statistic increased from 155.2 to 164.5; p<0.001), which is an improvement equivalent to the addition of the renal lesion grading to the clinical model.

Conclusions Retinopathy progression appeared to be associated with renal lesions and the development of ESKD. Our findings suggest that diabetic retinopathy and kidney disease share the same magnitude of disease progression, and therefore diabetic retinopathy may be useful for prognosticating the clinical course for diabetic kidney disease.

  • Diabetic Retinopathy
  • Diabetic Kidney Disease
  • Risk
  • End-stage Kidney Disease
  • Cohort
  • Renal Pathology

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  • Contributors MY, MM, JH and YU designed the study protocol, researched the data, contributed to discussion, wrote the manuscript, and reviewed and edited the manuscript. KK, TF, KO, KF and TW contributed to discussion, and reviewed and edited the manuscript. YU is the guarantor of this work, and as such had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This study was supported in part by a grant for medical research from the Okinaka Memorial Institute for Medical Research, Tokyo, Japan. The funding source had no role in study design or execution, data analysis, manuscript writing, or manuscript submission.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval An institutional review board at each hospital approved the study protocol.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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