Presence of retinopathy and incident kidney and cardiovascular events in type 2 diabetes with normoalbuminuria - A post-hoc analysis of the PRIORITY randomized clinical trial.

Aims: Baseline diabetic retinopathy (DR) and risk of development of microalbuminuria, kidney function decline, and cardiovascular events (CVEs) in type 2 diabetes.
Methods: Post-hoc analysis of the PRIORITY study including 1758 persons with type 2 diabetes and normoalbuminuria followed for a median of 2.5 (IQR: 2.0-3.0) years. DR diagnosis included non-proliferative and proliferative abnormalities, macular oedema, or prior laser treatment. Cox models were fitted to investigate baseline DR presence with development of persistent microalbuminuria (urinary albumin-creatinine ratio > 30 mg/g); chronic kidney disease (CKD) G3 (eGFR <60 ml/min/1.73m ² ); and CVE. Models were adjusted for relevant risk factors.
Results: At baseline, 304 (17.3 %) had DR. Compared to persons without DR, they were older (mean ± SD: 62.7 ± 7.7 vs 61.4 ± 8.3 years, p = 0.019), had longer diabetes duration (17.9 ± 8.4 vs. 10.6 ± 7.0 years, p < 0.001), and higher HbA _1c (62 ± 13 vs. 56 ± 12 mmol/mol, p < 0.001). The adjusted hazard ratios of DR at baseline for development of microalbuminuria (n = 197), CKD (n = 166), and CVE (n = 64) were: 1.50 (95%CI: 1.07, 2.11), 0.87 (95%CI: 0.56, 1.34), and 2.61 (95%CI: 1.44, 4.72), compared to without DR.
Conclusions: Presence of DR in normoalbuminuric type 2 diabetes was associated with an increased risk of developing microalbuminuria and CVE, but not with kidney function decline.
Competing Interests: Declaration of competing interest NT is a full-time employee of Novo Nordisk A/S. TWH has equity in Novo Nordisk A/S. ML has received research support from Boehringer Ingelheim, Bayer and Merck Sharp & Dohme, and lecture fees from AstraZeneca, Bayer and Boehringer Ingelheim. All fees are given to Holbaek hospital. FP has served as a consultant, on advisory boards or as educator for AstraZeneca, Novo Nordisk, Boehringer Ingelheim, Sanofi, Mundipharma, MSD, Novartis, Amgen and has received research grants to institution from Novo Nordisk, Boehringer Ingelheim, Amgen and AstraZeneca. AO has received grants from Sanofi and consultancy or speaker fees or travel support from Advicciene, Astellas, Astrazeneca, Amicus, Amgen, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Menarini, Mundipharma, Kyowa Kirin, Alexion, Freeline, Idorsia, Chiesi, Otsuka, Novo-Nordisk, Sysmex and Vifor Fresenius Medical Care Renal Pharma and is Director of the Catedra Mundipharma-UAM of diabetic kidney disease and the Catedra Astrazeneca-UAM of chronic kidney disease and electrolytes. HM is the cofounder and co-owner of Mosaiques Diagnostics GmbH. JS and PZ are employees of Mosaiques Diagnostics GmbH. MF-M has received speaker fees or support for medical meetings and research grants from AstraZeneca and Novo Nordisk and speaking fees from Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Novartis, Baxter, and Sanofi-Aventis. IR has received honoraria for lectures of AstraZenec, Bayer, Boehringer Ingelheim, and Mundipharma. PR has received research support and personal fees from AstraZeneca, Bayer and Novo Nordisk, and personal fees from Astellas Pharma Inc., Bayer, Boehringer Ingelheim, Eli Lilly and Company, Gilead, Merck, Merck Sharp & Dohme, Mundipharma, Sanofi, and Vifor Pharma. All fees are given to Steno Diabetes Center Copenhagen. All other authors declare no competing interests that could be perceived as affecting the impartiality of the reported results.
(Copyright © 2023 Elsevier Inc. All rights reserved.)