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Association of renal function with diabetic retinopathy and macular edema among patients with type 2 diabetes mellitus

Purpose: To investigate the associations between renal function and the presence of diabetic retinopathy (DR) in diabetic patients. Methods: A total of 1877 diabetic participants aged 30 to 80 years were consecutively recruited from October 2017 to April 2019. All participants underwent blood and urine analyses and standardized 7-field fundus imaging. The presence of DR, vision-threatening DR (VTDR) and DME was graded based on the fundus photographs. Renal function was defined as normal, mildly impaired or chronic kidney disease (CKD) based on different estimated glomerular filtration rates (GFRs). Results: Unlike a normal GFR, CKD was significantly associated with any DR (OR=1.89, P=0.017) and VTDR (OR=2.76, P=0.009), and mildly impaired renal function was associated with only any DR (OR=1.39, P=0.031). The analysis of the effect of microalbuminuria on relationship between GFR and DR showed that the GFR was associated with any DR only in the presence of microalbuminuria, while the GFR was an independent risk factor for VTDR regardless of microalbuminuria status (all P<0.05). The risks of any DR (OR=1.74 for quartile 2 and 3.09 for quartile 4) and VTDR (OR=3.27 for quartile 2 and 6.41 for quartile 4) increased gradually as the microalbuminuria quartile increased (all P<0.05). The third (OR=2.99, P=0.029) and fourth microalbuminuria quartiles (OR=4.74, P=0.002) were independent DME risk factors. Conclusions: There was a strong association between GFR and VTDR, whereas the association of GFR and any DR was significant only under the premise of microalbuminuria. High microalbuminuria was significantly associated with DR and DME.