ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Clinical Diabetes
Diabetic retinopathy severity is associated with renal function deterioration in patients with diabetic kidney disease: a retrospective cohort study
Provisionally accepted
- 1Endocrinology Department, China-Japan Friendship Hospital, Beijing, China
- 2Endocrinology Department, Shijiazhuang Second Hospital, Shijiazhuang, China
- 3Ophthalmology Department, China-Japan Friendship Hospital, Beijing, China
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Background: To investigate whether the severity of diabetic retinopathy (DR) and the presence of hard exudates (HEs) are associated with renal function deterioration in patients with diabetic kidney disease (DKD). Methods: This is a retrospective cohort study including 140 patients with DKD. The outcome was the progression of DKD (an estimated glomerular filtration (eGFR) decline (%)>15%) over a 5-year follow-up period. A total of 101 patients had eGFR parameters during the follow-up. DR was categorized into nonproliferative DR (NPDR) and proliferative DR (PDR). HEs were identified via optical coherence tomography (OCT). Clinical and laboratory data were acquired from medical records. The influence of the severity of DR and the presence of HEs were assessed via Cox regression. Results: The mean follow-up time was 34.31 (±16.36) months. A significant difference was found in eGFR decline (%) (P=0.024) between the absent DR, NPDR and PDR groups. eGFR decline (%) was more severe in patients with HEs than in those without HEs (P=0.011). After adjustment for age, body mass index (BMI), glycosylated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure, eGFR at baseline, urine albumin creatine ratio (UACR) stage at baseline, use of Sodium-Glucose Co-Transporter 2(SGLT2) inhibitors, as well as potential confounders such as duration of Diabetic mellitus (DM), use of Renin-Angiotensin System Inhibitors (RAS) inhibitors and Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RAs), Cox regression revealed that PDR (p=0.035) and NPDR (p=0.049) were independently associated with renal function deterioration. Compared with the participants in the absent DR group, participants with PDR, as well as NPDR presented a nearly threefold greater risk (adjusted HR = 2.88; 95% CI: 1.08–7.71; adjusted HR = 2.78; 95% CI: 1.004–7.70, respectively). However, the presence of HEs was not independently associated with renal function deterioration in the adjusted Cox model (P=0.567). Conclusions: DR severity was independently associated with the progression of DKD, whereas HEs were not. DKD patients with PDR as well as NPDR should undergo kidney function testing more frequently and receive early intervention to prevent renal function deterioration.
Keywords: Diabetic kidney disease, Diabetic Retinopathy, Estimated glomerular filtration, Hard exudates, Renal function deterioration
Received: 30 Nov 2025; Accepted: 09 Feb 2026.
Copyright: © 2026 Yu, Zhang, Sun, Zhao and Yan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yujie Yan
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