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Title:           The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes
Subject:         DOI: 10.1093/ckj/sfad142 Clinical Kidney Journal, 16, 10, 06-07-2023. Abstract: Up to 50–60% of patients with diabetes have non-diabetic kidney disease (NDKD) on kidney biopsy. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the kidney outcomes and survival in patients with biopsy diagnoses of DN and NDKD according to the presence of DR.We conducted an observational, multicentre and retrospective study of the pathological findings of renal biopsies from 832 consecutive patients with diabetes from 2002 to 2014 from 18 nephrology departments. The association of DR with kidney replacement therapy (KRT) or survival was assessed by Kaplan–Meier and Cox regression analyses.Of 832 patients with diabetes and renal biopsy, 768 had a retinal examination and 221/768 (22.6%) had DR. During a follow-up of 10 years, 288/760 (37.9%) patients with follow-up data needed KRT and 157/760 (20.7%) died. The incidence of KRT was higher among patients with DN (alone or with NDKD) and DR [103/175 (58.9%)] than among patients without DR [88/216 (40.7%), P < .0001]. The incidence of KRT was also higher among patients with only NDKD and DR than among those without DR [18/46 (39.1%) versus 79/331 (23.9%), P < .0001]. In multivariate analysis, DR or DN were independent risk factors for KRT {hazard ratio [HR] 2.48 [confidence interval (CI) 1.85–3.31], P < .001}. DN (with or without DR) was also identified as an independent risk factor for mortality [HR 1.81 (CI 1.26–2.62), P = .001].DR is associated with a higher risk of progression to kidney failure in patients with histological DN and in patients with NDKD.
Keywords:        diabetes mellitus, diabetic kidney disease, diabetic nephropathy, kidney biopsy, type 2 diabetes
Author:          Bermejo Sheila, González Ester, López-Revuelta Katia, Ibernon Meritxell, López Diana, Martín-Gómez Adoración, Garcia-Osuna Rosa, Linares Tania, Díaz Montserrat, Martín Nàdia, Barros Xoana, Marco Helena, Navarro Maruja Isabel, Esparza Noemí, Elias Sandra, Coloma Ana, Robles Nicolás Roberto, Agraz Irene, Poch Esteban, Rodas Lida, Lozano Víctor, Fernández-Fernández Beatriz, Hernández Eduardo, Martínez Maria Isabel, Stanescu Ramona Ionela, Moirón José Pelayo, García-Fernández Núria, Goicoechea Marian, Calero Francesca, Bonet Josep, Liaño Fernando, Pascual Julio, Bestard Oriol, Praga Manuel, Fulladosa Xavier, Soler María José
Creator:         OUP
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     Item: 
      Title: INTRODUCTION
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     Item: 
      Title: MATERIALS AND METHODS
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     Item: 
      Title: Patients
      Destination: section*.6
     Item: 
      Title: Clinical and laboratory parameters
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     Item: 
      Title: Statistical analysis
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     Item: 
      Title: RESULTS
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     Item: 
      Title: Baseline characteristics
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     Item: 
      Title: Relationship between DR and DN
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     Item: 
      Title: Relationship between DR and kidney outcomes
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     Item: 
      Title: Relationship between DR and mortality
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     Item: 
      Title: DISCUSSION
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     Item: 
      Title: SUPPLEMENTARY DATA
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   Info: 
    Title: The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes
    Author: Bermejo Sheila, González Ester, López-Revuelta Katia, Ibernon Meritxell, López Diana, Martín-Gómez Adoración, Garcia-Osuna Rosa, Linares Tania, Díaz Montserrat, Martín Nàdia, Barros Xoana, Marco Helena, Navarro Maruja Isabel, Esparza Noemí, Elias Sandra, Coloma Ana, Robles Nicolás Roberto, Agraz Irene, Poch Esteban, Rodas Lida, Lozano Víctor, Fernández-Fernández Beatriz, Hernández Eduardo, Martínez Maria Isabel, Stanescu Ramona Ionela, Moirón José Pelayo, García-Fernández Núria, Goicoechea Marian, Calero Francesca, Bonet Josep, Liaño Fernando, Pascual Julio, Bestard Oriol, Praga Manuel, Fulladosa Xavier, Soler María José
    Subject: DOI: 10.1093/ckj/sfad142 Clinical Kidney Journal, 16, 10, 06-07-2023. Abstract: Up to 50–60% of patients with diabetes have non-diabetic kidney disease (NDKD) on kidney biopsy. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the kidney outcomes and survival in patients with biopsy diagnoses of DN and NDKD according to the presence of DR.We conducted an observational, multicentre and retrospective study of the pathological findings of renal biopsies from 832 consecutive patients with diabetes from 2002 to 2014 from 18 nephrology departments. The association of DR with kidney replacement therapy (KRT) or survival was assessed by Kaplan–Meier and Cox regression analyses.Of 832 patients with diabetes and renal biopsy, 768 had a retinal examination and 221/768 (22.6%) had DR. During a follow-up of 10 years, 288/760 (37.9%) patients with follow-up data needed KRT and 157/760 (20.7%) died. The incidence of KRT was higher among patients with DN (alone or with NDKD) and DR [103/175 (58.9%)] than among patients without DR [88/216 (40.7%), P < .0001]. The incidence of KRT was also higher among patients with only NDKD and DR than among those without DR [18/46 (39.1%) versus 79/331 (23.9%), P < .0001]. In multivariate analysis, DR or DN were independent risk factors for KRT {hazard ratio [HR] 2.48 [confidence interval (CI) 1.85–3.31], P < .001}. DN (with or without DR) was also identified as an independent risk factor for mortality [HR 1.81 (CI 1.26–2.62), P = .001].DR is associated with a higher risk of progression to kidney failure in patients with histological DN and in patients with NDKD.
    Keywords: diabetes mellitus, diabetic kidney disease, diabetic nephropathy, kidney biopsy, type 2 diabetes
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               <rdf:li>Martín Nàdia</rdf:li>
               <rdf:li>Barros Xoana</rdf:li>
               <rdf:li>Marco Helena</rdf:li>
               <rdf:li>Navarro Maruja Isabel</rdf:li>
               <rdf:li>Esparza Noemí</rdf:li>
               <rdf:li>Elias Sandra</rdf:li>
               <rdf:li>Coloma Ana</rdf:li>
               <rdf:li>Robles Nicolás Roberto</rdf:li>
               <rdf:li>Agraz Irene</rdf:li>
               <rdf:li>Poch Esteban</rdf:li>
               <rdf:li>Rodas Lida</rdf:li>
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               <rdf:li>Martínez Maria Isabel</rdf:li>
               <rdf:li>Stanescu Ramona Ionela</rdf:li>
               <rdf:li>Moirón José Pelayo</rdf:li>
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               <rdf:li xml:lang="x-default">DOI: 10.1093/ckj/sfad142 Clinical Kidney Journal, 16, 10, 06-07-2023. Abstract: Up to 50&amp;#x2013;60&amp;#x0025; of patients with diabetes have non-diabetic kidney disease (NDKD) on kidney biopsy. Diabetic retinopathy (DR) is a microvascular complication of diabetes frequently associated with diabetic nephropathy (DN). The objective of the current study was to investigate the kidney outcomes and survival in patients with biopsy diagnoses of DN and NDKD according to the presence of DR.We conducted an observational, multicentre and retrospective study of the pathological findings of renal biopsies from 832 consecutive patients with diabetes from 2002 to 2014 from 18 nephrology departments. The association of DR with kidney replacement therapy (KRT) or survival was assessed by Kaplan&amp;#x2013;Meier and Cox regression analyses.Of 832 patients with diabetes and renal biopsy, 768 had a retinal examination and 221/768 (22.6&amp;#x0025;) had DR. During a follow-up of 10&amp;#x00A0;years, 288/760 (37.9&amp;#x0025;) patients with follow-up data needed KRT and 157/760 (20.7&amp;#x0025;) died. The incidence of KRT was higher among patients with DN (alone or with NDKD) and DR &amp;#x005B;103/175 (58.9&amp;#x0025;)&amp;#x005D; than among patients without DR &amp;#x005B;88/216 (40.7&amp;#x0025;), P&amp;#x00A0;&amp;#x003C;&amp;#x00A0;.0001&amp;#x005D;. The incidence of KRT was also higher among patients with only NDKD and DR than among those without DR &amp;#x005B;18/46 (39.1&amp;#x0025;) versus 79/331 (23.9&amp;#x0025;), P&amp;#x00A0;&amp;#x003C;&amp;#x00A0;.0001&amp;#x005D;. In multivariate analysis, DR or DN were independent risk factors for KRT {hazard ratio &amp;#x005B;HR&amp;#x005D; 2.48 &amp;#x005B;confidence interval (CI) 1.85&amp;#x2013;3.31&amp;#x005D;, P&amp;#x00A0;&amp;#x003C;&amp;#x00A0;.001}. DN (with or without DR) was also identified as an independent risk factor for mortality &amp;#x005B;HR 1.81 (CI 1.26&amp;#x2013;2.62), P&amp;#x00A0;&amp;#x003D;&amp;#x00A0;.001&amp;#x005D;.DR is associated with a higher risk of progression to kidney failure in patients with histological DN and in patients with NDKD.</rdf:li>
            </rdf:Alt>
         </dc:description>
         <dc:subject>
            <rdf:Bag>
               <rdf:li>diabetes mellitus</rdf:li>
               <rdf:li>diabetic kidney disease</rdf:li>
               <rdf:li>diabetic nephropathy</rdf:li>
               <rdf:li>kidney biopsy</rdf:li>
               <rdf:li>type 2 diabetes</rdf:li>
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         <dc:title>
            <rdf:Alt>
               <rdf:li xml:lang="x-default">The coexistence of diabetic retinopathy and diabetic nephropathy is associated with worse kidney outcomes</rdf:li>
            </rdf:Alt>
         </dc:title>
         <dc:creator>
            <rdf:Seq>
               <rdf:li>Bermejo Sheila, González Ester, López-Revuelta Katia, Ibernon Meritxell, López Diana, Martín-Gómez Adoración, Garcia-Osuna Rosa, Linares Tania, Díaz Montserrat, Martín Nàdia, Barros Xoana, Marco Helena, Navarro Maruja Isabel, Esparza Noemí, Elias Sandra, Coloma Ana, Robles Nicolás Roberto, Agraz Irene, Poch Esteban, Rodas Lida, Lozano Víctor, Fernández-Fernández Beatriz, Hernández Eduardo, Martínez Maria Isabel, Stanescu Ramona Ionela, Moirón José Pelayo, García-Fernández Núria, Goicoechea Marian, Calero Francesca, Bonet Josep, Liaño Fernando, Pascual Julio, Bestard Oriol, Praga Manuel, Fulladosa Xavier, Soler María José</rdf:li>
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