Diabetic Retinopathy Prevalent Among African Americans with T2D, End-Stage Kidney Disease

Zohyra E. Zabala, MD

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New research indicates diabetic retinopathy was observed in approximately 75% of African American patients with diabetes and end-stage-kidney disease on hemodialysis.¹

The findings, presented at the 83rd Scientific Sessions of the American Diabetes Association (ADA 2023), suggest end-stage kidney disease has a significant burden on general health and quality of life in these patients, but diabetic retinopathy had a minor additional impact on the population.

“Although end-stage kidney disease has a notable impact on overall health and quality of life, the presence of diabetic retinopathy appears to have a relatively minor additional effect on their overall physical health and quality of life,” wrote the investigative team, led by Zohyra E. Zabala, MD, from the division of endocrinology at Emory University School of Medicine.

Globally, working-age adults are suffering from legal blindness and end-stage kidney disease as the prevalence of diabetes continues to increase. Retinopathy is a common complication of diabetes and is projected to increase exponentially in the coming decades.² Visual disturbance and diabetic retinopathy is prevalent in patients with end-stage kidney disease.

Compared with non-Hispanic White patients, non-Hispanic Black patients are at a greater risk of developing significant retinopathy and vision loss. African American patients are also more likely to develop chronic disease and require renal replacement therapy when compared with non-Hispanic White patients.

However, the prevalence, severity, and quality of life impact of diabetic retinopathy among African American patients with end-stage kidney disease receiving dialysis are not well understood.¹ The current analysis aimed to determine the prevalence and severity of diabetic retinopathy among this population and assess its impact on quality of life. Zabala and colleagues conducted a prospective cross-sectional study in a total of 93 African American adults with type 1 (n = 9) and type 2 (n = 84) diabetes with end-stage kidney disease on hemodialysis.

Diagnoses of diabetic retinopathy were based on a review of medical records and/or a positive retinal photograph on a portable hand-held device reviewed using both an artificial intelligence retinal screening system and retinal specialist evaluation. A patient’s visual acuity was measured with the Snellen chart and standardized questionnaires were used to assess patient characteristics. Investigators measured associations with quality of life using kidney disease quality of life and depression questionnaires, associations with a physical disability using visual impairment questionnaires, and social determinants of health, including personal and household income, marital status, health insurance, education, food insecurity, or employment status.

Upon analysis, the overall prevalence of diabetic retinopathy was 75%, with 33% of patients having mild, 9.6% having moderate, and 57.4% having severe diabetic retinopathy. The analysis showed 43% had normal visual acuity, 45% had moderate, and 12% had severe visual impairment.

Investigators noted a high burden of disease, multiple social determinants of health challenges, and low quality of life among all patients, with most being unemployed or disabled, living below the poverty line, and mainly receiving public health insurance. As well, patients reported poor general health and substantial time dealing with kidney disease interfering with daily and family activities.

However, the analysis suggested the presence of diabetic retinopathy had no significant impact on either physical health and/or quality of life compared to patients without diabetic retinopathy.

References

1. Zabala ZE, Moazzami B, Egeolu M, Caleon RL, Gerges AYG, Galindo RJ, Mccoy RG, Peng L, Umpierrez GE. Prevalence and Impact on Quality of Life of Diabetic Retinopathy in African Americans with End-Stage Kidney Disease on Hemodialysis. Poster presentation at the 83rd Scientific Sessions of the American Diabetes Association. June 23 – 26, 2023.
2. Saaddine JB, Honeycutt AA, Narayan KMV, Zhang X, Klein R, Boyle JP. Projection of Diabetic Retinopathy and Other Major Eye Diseases Among People With Diabetes Mellitus: United States, 2005-2050. Arch Ophthalmol. 2008;126(12):1740–1747. doi:10.1001/archopht.126.12.1740