Stepwise Relationship Found Between Declining Renal Function and DR

It has been determined that people with diabetes who also receive hemodialysis for kidney dysfunction are at increased risk of diabetic retinopathy (DR) and other ocular complications. However, a recent study presented at ARVO 2026 in Denver found that there appears to be a progressive relationship between declining renal function and DR risk with or without DME starting at the mild-to-moderate stage of kidney disease ( known as G3a). For patients with NPDR, worsening kidney function increases the risk of DME further. Photo: National Kidney Foundation. Click image to enlarge. “Purposeful ophthalmic screening in diabetic patients with impaired renal function remains crucial to treating this sight-threatening condition,” the study authors from Boston Medical Center wrote in their abstract.This retrospective longitudinal cohort study analyzed electronic health record data from the TriNetX network. Patients diagnosed with type 2 diabetes from 2010 to 2020 were grouped by baseline estimated glomerular filtration rate levels.G1: normal/high (≥90mL/min) served as the control group, while the following stages served as the study group:G3a: mild-to-moderate chronic kidney disease (45 to 59mL/min)G3b: moderate-to-severe chronic kidney disease (30 to 44mL/min)G4: severe chronic kidney disease (15 to 29mL/min)G5: end-stage renal disease (<15mL/min).Propensity score matching on a 1:1 basis was conducted to include the following variables: hemoglobin A1c, hypertension, diabetes medications, alcohol history, obesity, BMI, antilipemic agents, ACE inhibitors and angiotensin II receptor blockers. Hazard ratios (HR) were calculated to assess the risk of NPDR with or without DME, and PDR with or without DME from stages G3 to G5 compared to patients with normal G1 kidney function.Compared to patients with normal G1 kidney function, there was a stepwise statistically significant higher risk of PDR and NPDR for those without DME.For patients at stage G3a, HR for PDR: 2.02, for NPDR: 1.10Stage G3b, HR: 2.85 (PDR), 1.25 (NPDR)Stage G4, HR: 4.236 (PDR), 1.33 (NPDR)Stage G5, HR 4.65 (PDR), 1.24 (NPDR)In those with DME, there was also a stepwise statistically significant higher risk of PDR and NPDR as kidney function declined.For patients at stage G3a, HR for PDR: 1.96, for NPDR: 1.26Stage G3b, HR 3.01 (PDR), 1.57 (NPDR)Stage G4 HR: 4.48 (PDR), 1.88 (NPDR)Stage G5 HR 4.37 (PDR), 1.67 (NPDR)“Worsening kidney function appeared to further increase the risk of DME, particularly for those with NPDR, but not as much for those with PDR,” the researchers noted. Original abstract ©2026 Association for Research in Vision and Ophthalmology. Click here for the source. Menard M, Manhapra A, Lu W, et al. The association between kidney function decline and diabetic retinopathy severity. ARVO 2026 annual meeting. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.