Journal
OPHTHALMIC RESEARCH
Volume 62, Issue 2, Pages 68-79Publisher
KARGER
DOI: 10.1159/000500833
Keywords
Diabetic retinopathy; Diabetic nephropathy; Diagnosis; Type 2 diabetes; Meta-analysis
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Funding
- Science and Technology Project of Beijing [D171100002817003, D171100002817002]
- National Key R&D Program of China [2016YFC1305500]
- China Health Promotion Foundation [2018-2022]
- National Natural Science Foundation of China [81600547]
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Aims: To conduct an evidence-based evaluation of diabetic retinopathy (DR) for the diagnosis of diabetic nephropathy (DN) in type 2 diabetics with kidney disease. Methods: We systematically searched PubMed, EMBASE, and the Cochrane Library from inception to June 27, 2018, including the reference lists of identified primary studies. A study was included if it (1) used DR as a diagnostic test for DN; and (2) used histological evaluation of renal tissues as the reference standard. Results: The analysis included 45 studies (4,561 patients). A bivariate analysis yielded a sensitivity of 0.67 (95% CI 0.61-0.74) and a specificity of 0.78 (95% CI 0.73-0.82). The summary receiver operating characteristic curve analysisprovided an area under the curve (AUC) of 0.79 (95% CI 0.76-0.83). In a setting of 41% prevalence of DN, the probability of DN would be 68% if the test of DR was positive, and the probability of DN would be 23% if it was negative. In addition, although the mean specificity of proliferative DR for the detection of DN was 0.99 (95% CI 0.45-1.00), the mean sensitivity was 0.34 (95% CI 0.24-0.44), and the AUC was 0.58 (95% CI 0.53-0.62). Conclusions: DR is helpful in diagnosing DN in persons with type 2 diabetes and kidney disease, but the severity of DR may not parallel the presence of DN.
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