Diabetes retinopathy is a poor predictor for renal and cardiovascular outcomes in comparison with hypertensive retinopathy in patients with chronic kidney disease

- Diabetic retinopathy was associated with rapid CKD progression.
- Diabetic retinopathy was associated with cardiovascular events and mortality in CKD.
- Hypertensive retinopathy was not associated with adverse outcomes.

AimsChronic 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.MethodsWe 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.ResultsDMR 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 ± 9.8 mL/min/1.73 m2/yr vs. −2.4 ± 7.6 mL/min/1.73 m2/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.ConclusionCoexistence 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.