Diabetic eye disease and kidney disease linked

51BDaYQGjNLThere is a new study I want to share with you that is important for you as a diabetic.  It was published on the April 25 online version of Diabetes Care and is based on data from the Japan Diabetes Complication Study (JDCS).  First a bit of background.

Diabetic kidney disease (or renal disease) is a big problem.  The high blood sugar in diabetes damages blood vessels in the kidneys, which leads to poor kidney function.  The job of your kidneys is to filter your blood, removing the bad stuff from your blood and getting rid of the toxins through your pee.  When lots of damage occurs to the kidneys, they can’t filter the blood very well, and in severe cases, the kidneys fail almost completely.  You can’t make pee, and the toxins build up in your body.  In such cases, where the kidneys have failed, we use a machine instead to filter your blood.  We call this machine a dialysis machine.  People who are on renal dialysis typically need to get hooked up to the dialysis machine for about four hours, three times a week, to get their blood filtered, purified, and put back into their bodies. This is an effective, but not a very convenient way to purify your blood.  Better to keep your kidneys if you can.

If we want to see early damage to the blood vessels in the retina, we just look into the eye.  But we can’t look into the kidney.  So how can we tell if the kidney is being damaged?  Well, it turns out that there is a small protein in our blood called albumin.  Usually, the albumin stays in the blood and doesn’t come out in your pee.  But when the kidneys start to get damaged, the kidneys start to leak albumin.  We can test your urine to see if it has albumin in it.  Microalbuminuria,  which means small amounts (“micro”) of albumin in the urine (“urea”), is a sign that kidney damage is starting.

The JDCS found that damage to the blood vessels in the retina, diabetic retinopathy,  is a risk factor for development of kidney failure.  They also found that microalbuminuria is also a risk factor for kidney failure.  Basically, if either of these were present, they were predictive of a faster rate of decline of the kidney’s ability to filter the blood, or what we call glomelular filtration rate (GFR).

In their study of 1475 patients who were followed over 8 years, they found that those who had either retinopathy or microalbinuria had increased rates of decline in GFR, but they found that those patients who had both retinopathy and microalbuminuria and a 2-3 times greater risk of progressive kidney disease than those who had neither.

Because it is so important to catch the beginning stages of kidney failure, we now have markers that can tell us someone is at higher risk.  It is vitally important that eye doctors and diabetes doctors communicate about the findings of retinopathy, even when mild, because we now know that the retinopathy is a predictor of worsening kidney disease.  Make sure your eye specialist is communicating your retinal findings to your other doctors.


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