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We analysed two population-based cohorts, composing of 1,221 Asians (SEED) and 703 White (WESDR) adults with diabetes. Retinal microvascular signs at baseline included vascular caliber (arteriolar\u2014CRAE, and venular\u2014CRVE) and diabetic retinopathy (DR). Incident cases of DKD were identified after\u2009~\u20096-year. Incident cases were defined based on eGFR in SEED and proteinuria or history of renal dialysis in WESDR. The incidence of DKD were 11.8% in SEED and 14.0% in WESDR. Wider CRAE in SEED (OR\u2009=\u20091.58 [1.02, 2.45]) and wider CRVE (OR\u2009=\u20091.69 [1.02, 2.80)) in WESDR were associated with increased risk of DKD. Presence of DR was associated with an increased risk of DKD in both cohorts (SEED: OR\u2009=\u20091.91 [1.21, 3.01] in SEED, WESDR: OR\u2009=\u20091.99 [1.18, 3.35]). Adding DR and retinal vascular calibers in the model beyond traditional risk factors led to an improvement of predictive performance of DKD risk between 1.1 and 2.4%; and improved classification (NRI 3 between 9%). Microvascular changes in the retina are longitudinally associated with risk of DKD.<\/jats:p>","DOI":"10.1038\/s41598-021-84464-7","type":"journal-article","created":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T11:07:32Z","timestamp":1614596852000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Retinal microvascular signs and risk of diabetic kidney disease in asian and white populations"],"prefix":"10.1038","volume":"11","author":[{"given":"Simon","family":"Nusinovici","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charumathi","family":"Sabanayagam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine E.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol Y.","family":"Cheung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. 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