1
|
Egeolu M, Caleon RL, Manishimwe E, Zabala ZE, Moazzami B, Gerges A, O'Keefe GD, Navarrete J, Galindo RJ, McCoy RG, Vellanki P, Peng L, Umpierrez GE. Diabetic retinopathy in African-Americans with end-stage kidney disease: a cross-sectional study on prevalence and impact on quality of life. BMJ Open Diabetes Res Care 2023; 11:e003373. [PMID: 37402594 DOI: 10.1136/bmjdrc-2023-003373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/29/2023] [Indexed: 07/06/2023] Open
Abstract
INTRODUCTION The prevalence, severity, and quality of life (QoL) impact of diabetic retinopathy (DR) among African-Americans (AAs) with end-stage kidney disease (ESKD) undergoing dialysis are unknown. RESEARCH DESIGN AND METHODS A cross-sectional study was conducted on 93 AA adults with diabetes and ESKD. The diagnosis of DR was based on a review of medical records and/or a positive photograph with a portable hand-held device reviewed by both artificial intelligence software and a retinal specialist. QoL, physical disability social determinants of health (SDoHs) were assessed by standardized questionnaires. RESULTS The prevalence of DR was 75%, with 33% of participants having mild, 9.6% moderate and 57.4% severe DR. A total of 43% had normal visual acuity; 45% had moderate visual impairment; and 12% had severe visual impairment. We found a high burden of disease, multiple SDoH challenges, and low QoL and general health among patients with ESKD. The presence of DR had no significant impact on physical health and QoL compared with participants without DR. CONCLUSIONS DR is present in 75% of AA patients with diabetes and ESKD on haemodialysis. ESKD has a significant burden on general health and QoL; however, DR has a minor additional impact on the overall physical health and QoL in people with ESKD.
Collapse
Affiliation(s)
- Michelle Egeolu
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ramoncito L Caleon
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Biostatistics, Emory University Atlanta, Atlanta, Georgia, USA
| | - Exaucee Manishimwe
- Department of Biostatistics, Emory University Atlanta, Atlanta, Georgia, USA
| | - Zohyra E Zabala
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bobak Moazzami
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amany Gerges
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ghazala D O'Keefe
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jose Navarrete
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rodolfo J Galindo
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rozalina Grubina McCoy
- Division of Endocrinology, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - Limin Peng
- Departent of Medicine, Emory University, Atlanta, Georgia, USA
| | | |
Collapse
|
2
|
Is Chronic Kidney Disease Affecting the Postoperative Complications of Vitrectomy for Proliferative Diabetic Retinopathy? J Clin Med 2021; 10:jcm10225309. [PMID: 34830589 PMCID: PMC8621452 DOI: 10.3390/jcm10225309] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Chronic kidney disease (CKD) is a well-known risk factor for postoperative complications in several surgical fields. However, although prevalent among diabetic candidates for vitrectomy, the effect of CKD on vitrectomy outcomes remains unclear. This study aimed at clarifying the relationship between CKD and the occurrence of vitrectomy-related complications in patients with proliferative diabetic retinopathy (PDR). The 6-month incidences of vitreous hemorrhage (VH) and neovascular glaucoma (NVG) following vitrectomy for PDR were compared among the following groups: stages 1–2 CKD (60 patients), stages 3–5 CKD (70 patients not on hemodialysis), and hemodialysis (HD; 30 patients). We also determined whether the deterioration of the estimated glomerular filtration rate (eGFR) was associated with post-vitrectomy events. The incidence of VH was significantly higher in the stages 3–5 CKD group (43%) than in the stages 1–2 CKD (10%) and HD (10%) groups. NVG was more common in the stages 3–5 CKD group (17%) than in the stages 1–2 CKD (2%) and HD (0%) groups. The reduced estimated glomerular filtration rate (eGFR) was the only significant variable associated with post-vitrectomy VH and NVG. Patients with PDR and CKD, particularly those with lower eGFR, might be at risk for post-vitrectomy VH and NVG.
Collapse
|
3
|
Alalawi F, Bashier A. Management of diabetes mellitus in dialysis patients: Obstacles and challenges. Diabetes Metab Syndr 2021; 15:1025-1036. [PMID: 34000713 DOI: 10.1016/j.dsx.2021.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Diabetic kidney disease (DKD) is a major health issue that is associated with an increased risk of morbidity and mortality. The treatment of DKD is challenging given changes in blood glucose homeostasis, unclear accuracy of glucose metrics, and altered kinetics of the blood glucose-lowering medications. There is uncertainty surrounding the optimal glycemic target in this population although recent epidemiologic data suggest that HbA1c ranges of 6-8%, as well as 7-9%, are associated with increased survival rates among diabetic dialysis patients. Furthermore, the treatment of diabetes in patients maintained on dialysis is challenging, and many blood glucose-lowering medications are renally metabolized and excreted hence requiring dose adjustment or avoidance in dialysis patients. METHOD ology: PubMed, Google Scholar, and Medline were searched for all literature discussing the management of diabetes in dialysis patients. RESULTS The literature was discussed under many subheadings providing the latest evidence in the treatment of diabetes in dialysis patients. CONCLUSION The management of diabetes in dialysis is very complex requiring a multi-disciplinary team involving endocrinologists and nephrologists to achieve targets and reduce morbidity and mortality.
Collapse
Affiliation(s)
- Fakhriya Alalawi
- Nephrology Department, Dubai Hospital. Dubai Health Authority, United Arab Emirates
| | - Alaaeldin Bashier
- Endocrine Department, Dubai Hospital. Dubai Health Authority, United Arab Emirates.
| |
Collapse
|
4
|
Kameda Y, Hanai K, Uchigata Y, Babazono T, Kitano S. Vitreous hemorrhage in diabetes patients with proliferative diabetic retinopathy undergoing hemodialysis. J Diabetes Investig 2020; 11:688-692. [PMID: 31618517 PMCID: PMC7232265 DOI: 10.1111/jdi.13161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/24/2019] [Accepted: 10/14/2019] [Indexed: 11/29/2022] Open
Abstract
AIMS/INTRODUCTION For diabetes patients undergoing hemodialysis, vitreous hemorrhage seems to be a hemodialysis-induced hemorrhagic complication because of the effect of systemic anticoagulation. However, it is unclear whether hemodialysis is associated with vitreous hemorrhage in diabetes patients. We therefore carried out this cohort study to clarify the relationship between hemodialysis and vitreous hemorrhage in diabetes patients with proliferative diabetic retinopathy. MATERIALS AND METHODS This was a single-center, retrospective, cohort study. We compared the incidence of vitreous hemorrhage in non-vitrectomized proliferative diabetic retinopathy eyes between the hemodialysis group (145 eyes) and peritoneal dialysis group (36 eyes), which does not require the use of systemic anticoagulation (parallel-group study), and in hemodialysis patients in the 12-month period before and after the start of hemodialysis (before-after study). We also determined the risk factors for vitreous hemorrhage after the start of hemodialysis based on the patients' systemic and ophthalmic characteristics. RESULTS There was no significant difference in the first-year incidence of vitreous hemorrhage between the hemodialysis (23.4%) and peritoneal dialysis groups (22.2%, P = 1.000). The incidence of vitreous hemorrhage in the dialysis period (23.4%) was significantly lower than that in the predialysis period (35.2%, P = 0.008). Only application of panretinal photocoagulation within the 6 months immediately before hemodialysis was significantly associated with the incidence of vitreous hemorrhage after the start of hemodialysis (P < 0.001). CONCLUSIONS Hemodialysis therapy does not seem to be associated with a higher risk of vitreous hemorrhage in diabetes patients with proliferative diabetic retinopathy.
Collapse
Affiliation(s)
- Yusuke Kameda
- Department of OphthalmologyDiabetes CenterSchool of MedicineTokyo Women’s Medical UniversityTokyoJapan
| | - Ko Hanai
- Department of MedicineDiabetes CenterSchool of MedicineTokyo Women’s Medical UniversityTokyoJapan
| | - Yasuko Uchigata
- Department of MedicineDiabetes CenterSchool of MedicineTokyo Women’s Medical UniversityTokyoJapan
- Tokyo Women’s Medical University Medical Center EastTokyoJapan
| | - Tetsuya Babazono
- Department of MedicineDiabetes CenterSchool of MedicineTokyo Women’s Medical UniversityTokyoJapan
| | - Shigehiko Kitano
- Department of OphthalmologyDiabetes CenterSchool of MedicineTokyo Women’s Medical UniversityTokyoJapan
| |
Collapse
|
5
|
Okolo OE, Omoti AE. Ocular manifestations of chronic kidney disease among adult patients receiving hemodialysis. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.12.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
6
|
Hietala K, Forsblom C, Summanen P, Groop PH. Higher age at onset of type 1 diabetes increases risk of macular oedema. Acta Ophthalmol 2013; 91:709-15. [PMID: 22973826 DOI: 10.1111/j.1755-3768.2012.02522.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate whether age at onset of type 1 diabetes is a risk factor for clinically significant macular oedema (CSME). METHODS A sample of 1354 patients with a mean duration of diabetes 24.6 ± 11.6 years was drawn from the FinnDiane Study population and divided into age at onset groups 0-4 (n = 184), 5-14 (n = 662) and 15-40 years (n = 508). Type 1 diabetes was defined as age at onset ≤40 years, C-peptide negativity and insulin treatment initiated within 1 year of diagnosis. Retinopathy status was assessed from fundus photographs and stereoscopic fundus examinations and graded with the ETDRS scale. RESULTS After 30 years of diabetes, the estimated cumulative incidences of CSME were 17% (95% CI 11-26) in age at onset group 0-4 years, 27% (95% CI 23-32) in age at onset group 5-14 years and 34% (95% CI 27-41) in age at onset group 15-40 years (p = 0.002, Gray's test). In a competing risks regression model, adjusted for covariates selected with Bayesian information criteria, age at onset 5-14 years (HR 1.89 [95% CI 1.22-2.91], p = 0.004), and age at onset 15-40 years (HR 3.72 [95% CI 2.35-5.89], p < 0.0001), were significant overall risk factors for CSME (p < 0.0001). Higher ETDRS score (HR 1.04 ([95% CI 1.03-1.05], p < 0.0001), HbA1c (HR 1.12 [95% CI 1.02-1.23], p = 0.016), and total cholesterol (HR 1.19 [95% CI 1.04-1.37], p = 0.013) also increased the risk of CSME. CONCLUSIONS Higher age at onset of type 1 diabetes is a significant risk factor for macular oedema. This suggests that ageing may modify the risk of retinopathy in type 1 diabetes.
Collapse
Affiliation(s)
- Kustaa Hietala
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, FinlandDepartment of Ophthalmology, Helsinki University Central Hospital, Helsinki, FinlandDivision of Nephrology, Department of Medicine, Helsinki University Central Hospital, Helsinki, FinlandThe Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia
| | | | | | | |
Collapse
|
7
|
Theodossiadis PG, Theodoropoulou S, Neamonitou G, Grigoropoulos V, Liarakos V, Triantou E, Theodossiadis GP, Vlahakos DV. Hemodialysis-induced alterations in macular thickness measured by optical coherence tomography in diabetic patients with end-stage renal disease. Ophthalmologica 2011; 227:90-4. [PMID: 21921588 DOI: 10.1159/000331321] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 06/29/2011] [Indexed: 01/07/2023]
Abstract
BACKGROUND/AIMS To evaluate changes in macular thickness measured by optical coherence tomography (OCT) during a hemodialysis (HD) session in diabetic patients with end-stage renal disease. METHODS 72 eyes of 36 diabetic patients with and without macular edema were evaluated before and immediately after an HD session. Average and maximum macular thicknesses in the central disk (6 mm in diameter) and total macular volume were measured. RESULTS In the eyes with diabetic macular edema, maximum macular thickness within the central disk of 6 mm, and mainly in its peripheral parts, was significantly reduced by 31.18 ± 4.18 μm after HD (p < 0.001). Average macular thickness and total macular volume were also significantly reduced (p = 0.003 and 0.015, respectively). In diabetic eyes without edema, maximum macular thickness decreased significantly by 11.21 ± 1.98 μm after HD (p < 0.001), while average macular thickness and total macular volume decreased slightly (p = 0.034, p = 0.043). Best-corrected visual acuity failed to change. We found a significant association of macular thickness changes with osmolality reduction and the presence of macular edema. CONCLUSION HD decreases macular thickness in diabetic patients with macular edema, while there exists a less-pronounced effect in diabetic eyes without edema.
Collapse
|
8
|
Conway BN, Miller RG, Klein R, Orchard TJ. Prediction of proliferative diabetic retinopathy with hemoglobin level. ARCHIVES OF OPHTHALMOLOGY (CHICAGO, ILL. : 1960) 2009; 127:1494-9. [PMID: 19901215 PMCID: PMC2778312 DOI: 10.1001/archophthalmol.2009.274] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To investigate the role of hemoglobin (HGB) level in predicting proliferative diabetic retinopathy (PDR). METHODS We assessed 426 individuals without PDR at baseline (213 men; 213 women) from the Pittsburgh Epidemiology of Diabetes Complications Study, an 18-year prospective cohort study of childhood-onset type 1 diabetes. Presence of PDR was determined by stereo fundus photography. Cox proportional hazards modeling with stepwise regression was used to determine the independent association of HGB level with PDR. Analyses were sex specific. RESULTS There were 206 events. Although the incidence of PDR did not vary by sex (48% in both men and women), in men, HGB exhibited a positive linear relationship with 18-year incidence of PDR (hazard ratio, 1.33; 95% confidence interval, 1.10-1.60; P = .003), while in women, HGB level exhibited a quadratic relationship with PDR (P < .001). After multivariable adjustment for univariately significant covariates, HGB level remained significantly predictive of PDR in both men (P = .004) and women (P = .04). CONCLUSION Higher HGB level predicts the incidence of PDR in type 1 diabetes mellitus, though the association varies by sex, being linear and positive in men and quadratic in women.
Collapse
|
9
|
Hietala K, Forsblom C, Summanen P, Groop PH. Heritability of proliferative diabetic retinopathy. Diabetes 2008; 57:2176-80. [PMID: 18443200 PMCID: PMC2494680 DOI: 10.2337/db07-1495] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 04/22/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Diabetic nephropathy clusters in families, suggesting that genetic factors play a role in its pathogenesis. We investigated whether similar clustering exists for proliferative retinopathy in families with two or more siblings with type 1 diabetes. RESEARCH DESIGN AND METHODS The FinnDiane Study has characterized 20% (4,800 patients) of adults with type 1 diabetes in Finland. In 188 families, there were at least two siblings with type 1 diabetes. Ophthalmic records were obtained for 369 of 396 (93%) and fundus photographs for 251 of 369 (68%) patients. Retinopathy was graded based on photographs and/or repeated ophthalmic examinations using the Early Treatment of Diabetic Retinopathy grading scale. RESULTS Mean age at onset of diabetes was 14.3 +/- 10.2 years, and mean duration was 25.9 +/- 11.8 years. Proliferative retinopathy was found in 115 of 369 patients (31%). The familial risk of proliferative retinopathy was estimated in 168 of 188 sibships, adjusted for A1C, duration, and mean blood pressure. Proliferative retinopathy in the probands (48 of 168) was associated with an increased risk (odds ratio 2.76 [95% CI 1.25- 6.11], P = 0.01) of proliferative retinopathy in the siblings of probands (61 of 182). The heritability of proliferative retinopathy was h(2) = 0.52 +/- 0.31 (P < 0.05). CONCLUSIONS We found a familial clustering of proliferative retinopathy in patients with type 1 diabetes. The observation cannot be accounted for by conventional risk factors, suggesting a genetic component in the pathogenesis of proliferative retinopathy in type 1 diabetes.
Collapse
Affiliation(s)
- Kustaa Hietala
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland
| | | | | | | |
Collapse
|
10
|
Markell MS. Preparing the Diabetic Urermic patient and Family for What Lies Ahead. Semin Dial 2007. [DOI: 10.1111/j.1525-139x.1997.tb00494.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
|
12
|
A Hypothesis: Can Erythropoietin Administration Affect the Severity of Retinopathy in Diabetic Patients With Renal Failure? Am J Med Sci 2007; 334:260-4. [DOI: 10.1097/maj.0b013e3180a5e8ed] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
BIESENBACH G, ZAZGORNIK J. Vascular disease in type II diabetes: Progression before and after commencing haemodialysis. Nephrology (Carlton) 2007. [DOI: 10.1111/j.1440-1797.1997.tb00214.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
14
|
Abstract
PURPOSE To highlight the systemic factors which affect onset and/or progression of diabetic retinopathy (DR) and to emphasize the role and responsibilities of ophthalmologists and other eye care providers to ensure that appropriate systemic medical evaluation of the patient with diabetes is being pursued. DESIGN Literature review of publications relevant to diabetic retinopathy, blood glucose control, diabetes mellitus type, hypertension, renal disease, elevated serum lipids, exercise, pregnancy, anticoagulation, thrombolysis, smoking, anemia and antioxidant ingestion. FINDINGS Intensive blood glucose control and control of systemic hypertension reduce the risk of new onset DR and slow the progression of existing DR. Severe DR may be an indicator of renal disease while severe renal disease and its treatment can affect the progression of DR. Elevated serum lipids are associated with macular exudate and moderate visual loss. Certain types of excessive exercise in patients with advanced stages of retinopathy may aggravate vitreous hemorrhage. During pregnancy, DR should be monitored closely as transient progression of DR can occur. Therapeutic anticoagulation and thrombolysis are not contraindicated at any stage of DR. Anemia can result in progression of DR, smoking in general should be discouraged, and the role of antioxidant therapy requires further study. CONCLUSIONS Blindness from diabetic retinopathy is now largely preventable with timely detection and appropriate interventional therapy. Routine, repetitive, lifelong, expert clinical retinal examination is essential for the fundamental ophthalmic care of the patient with diabetes. However, diabetes mellitus is a systemic disease and thus optimal ophthalmic care must include diligent evaluation and treatment of concomitant systemic disorders that influence the development, progression and ultimate outcome of diabetic retinopathy. Optimization of these systemic considerations through an intensive, multi-disciplinary, healthcare team-based approach will maximize the ophthalmic and general health of these patients. Ophthalmologists and other eye care providers are critical members of this team with unique responsibilities to ensure that appropriate systemic medical evaluation is being pursued.
Collapse
Affiliation(s)
- L P Aiello
- Beetham Eye Institute, Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215, USA.
| | | | | |
Collapse
|
15
|
Abstract
Renal disorders attributed to diabetes mellitus are increasingly recognized as the dominant feature of long-term management. Renal failure in diabetic patients is the most commonly recognized cause of irreversible uremia in the United States, Europe, and Japan. Treating hypertension and normalizing hyperglycemia slows the previously thought inexorable progress of renal insufficiency in diabetes. Once end-stage renal disease has developed, either dialytic therapy or a renal transplant affords life extension, often with excellent rehabilitation.
Collapse
MESH Headings
- Blood Pressure
- Comorbidity
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/mortality
- Diabetes Mellitus, Type 1/physiopathology
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/mortality
- Diabetes Mellitus, Type 2/physiopathology
- Diabetic Nephropathies/diagnosis
- Diabetic Nephropathies/epidemiology
- Diabetic Nephropathies/physiopathology
- Diabetic Nephropathies/therapy
- Diet, Protein-Restricted
- Humans
- Hyperglycemia/prevention & control
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/etiology
- Kidney Failure, Chronic/physiopathology
- Kidney Failure, Chronic/therapy
- Kidney Transplantation/mortality
- Pancreas Transplantation/mortality
- Peritoneal Dialysis
- Renal Dialysis
- Risk Factors
- Survival Rate
- Treatment Outcome
Collapse
Affiliation(s)
- E A Friedman
- Department of Medicine, State University of New York, Brooklyn, USA
| |
Collapse
|