# A Cross-Sectional Comparative Study of Retinal Findings in Diabetic and Non-diabetic Chronic Kidney Disease Patients

## TL;DR

This study compares retinal changes in diabetic and non-diabetic chronic kidney disease patients, finding more severe retinal issues in those with diabetes.

## Contribution

The study provides comparative evidence on retinal findings in diabetic and non-diabetic CKD patients in the Indian population.

## Key findings

- Diabetic CKD patients had significantly reduced retinal thickness compared to non-diabetic CKD patients.
- Diabetic CKD patients showed more severe retinal microvascular and structural abnormalities.
- Diabetic CKD patients had higher serum creatinine levels and lower eGFR than non-diabetic CKD patients.

## Abstract

Background and objectives: Chronic kidney disease (CKD) is associated with systemic microvascular and macrovascular complications, including significant effects on the retina. While the link between diabetic retinopathy and diabetic CKD is well established, retinal involvement in non-diabetic CKD is less well recognized. Comparative evidence in the Indian population is limited, despite the high prevalence of both diabetes and CKD. This study aimed to compare retinal findings between patients with diabetic and non-diabetic CKD and to evaluate the spectrum of retinal changes across different CKD etiologies.

Methodology: This cross-sectional comparative study was conducted over 18 months at BLDE (Deemed to be University), Shri B. M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India, and included 76 patients, with 38 diabetic CKD and 38 non-diabetic CKD cases. Participants were recruited from inpatient and outpatient services and underwent detailed systemic and ophthalmologic evaluation, including visual acuity testing, fundus examination, and spectral-domain optical coherence tomography for macular and choroidal thickness. Data were analyzed using IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York, United States), applying the chi-square test, t-test, and Mann-Whitney U test as appropriate, with p<0.05 considered significant.

Results: The mean age of diabetic CKD patients was significantly higher (63.52 ± 14.43 years) than that of non-diabetic CKD patients (49.26 ± 15.22 years; p < 0.001). Diabetic CKD patients also had higher serum creatinine levels (4.33 ± 1.76 vs. 3.35 ± 1.56 mg/dL; p = 0.0008) and lower eGFR (18.95 ± 3.47 vs. 22.31 ± 2.78 mL/min/1.73 m²; p < 0.001). Retinal thickness across all quadrants was significantly reduced in diabetic CKD patients (e.g., subfoveal thickness: 220.11 ± 39.67 μm in the right eye vs. 265.50 ± 28.34 μm; p < 0.001).

Conclusion: This study highlights the substantial impact of diabetes on retinal health in CKD patients. Individuals with diabetic CKD exhibited significantly more severe retinal microvascular and structural abnormalities, such as marked macular thinning, advanced stages of diabetic retinopathy, and a higher incidence of dialysis, and associated retinal changes, compared to their non-diabetic counterparts.