{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T23:13:15Z","timestamp":1772147595473,"version":"3.50.1"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T00:00:00Z","timestamp":1693612800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001349","name":"National Medical Research Council","doi-asserted-by":"publisher","award":["NMRC\/STaR\/003\/2008"],"award-info":[{"award-number":["NMRC\/STaR\/003\/2008"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001349","name":"National Medical Research Council","doi-asserted-by":"publisher","award":["NMRC\/OFLCG\/001\/2017"],"award-info":[{"award-number":["NMRC\/OFLCG\/001\/2017"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001349","name":"National Medical Research Council","doi-asserted-by":"publisher","award":["NMRC\/MOH-HCSAINV21jun-0001"],"award-info":[{"award-number":["NMRC\/MOH-HCSAINV21jun-0001"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001321","name":"National Research Foundation","doi-asserted-by":"publisher","award":["AISG-GC-2019-001-2A"],"award-info":[{"award-number":["AISG-GC-2019-001-2A"]}],"id":[{"id":"10.13039\/501100001321","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000269","name":"Economic and Social Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000269","id-type":"DOI","asserted-by":"publisher"}]},{"name":"UKCRC Centre of Excellence for Public Health Northern Ireland"},{"DOI":"10.13039\/501100001582","name":"Centre for Ageing Research and Development in Ireland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001582","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004603","name":"Office of the First Minister and Deputy First Minister","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004603","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Health and Social Care Research and Development Division of the Public Health Agency"},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Wolfson Foundation, and Queen\u2019s University Belfast"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To develop a deep learning algorithm (DLA) to detect diabetic kideny disease (DKD) from retinal photographs of patients with diabetes, and evaluate performance in multiethnic populations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and methods<\/jats:title>\n                  <jats:p>We trained 3 models: (1) image-only; (2) risk factor (RF)-only multivariable logistic regression (LR) model adjusted for age, sex, ethnicity, diabetes duration, HbA1c, systolic blood pressure; (3) hybrid multivariable LR model combining RF data and standardized z-scores from image-only model. Data from Singapore Integrated Diabetic Retinopathy Program (SiDRP) were used to develop (6066 participants with diabetes, primary-care-based) and internally validate (5-fold cross-validation) the models. External testing on 2 independent datasets: (1) Singapore Epidemiology of Eye Diseases (SEED) study (1885 participants with diabetes, population-based); (2) Singapore Macroangiopathy and Microvascular Reactivity in Type 2 Diabetes (SMART2D) (439 participants with diabetes, cross-sectional) in Singapore. Supplementary external testing on 2 Caucasian cohorts: (3) Australian Eye and Heart Study (AHES) (460 participants with diabetes, cross-sectional) and (4) Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) (265 participants with diabetes, cross-sectional).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In SiDRP validation, area under the curve (AUC) was 0.826(95% CI 0.818-0.833) for image-only, 0.847(0.840-0.854) for RF-only, and 0.866(0.859-0.872) for hybrid. Estimates with SEED were 0.764(0.743-0.785) for image-only, 0.802(0.783-0.822) for RF-only, and 0.828(0.810-0.846) for hybrid. In SMART2D, AUC was 0.726(0.686-0.765) for image-only, 0.701(0.660-0.741) in RF-only, 0.761(0.724-0.797) for hybrid.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion and conclusion<\/jats:title>\n                  <jats:p>There is potential for DLA using retinal images as a screening adjunct for DKD among individuals with diabetes. This can value-add to existing DLA systems which diagnose diabetic retinopathy from retinal images, facilitating primary screening for DKD.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocad179","type":"journal-article","created":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T20:00:30Z","timestamp":1693684830000},"page":"1904-1914","source":"Crossref","is-referenced-by-count":32,"title":["Deep learning algorithms to detect diabetic kidney disease from\u00a0retinal photographs in multiethnic populations with diabetes"],"prefix":"10.1093","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4843-7514","authenticated-orcid":false,"given":"Bjorn Kaijun","family":"Betzler","sequence":"first","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore , 117597, Singapore"}]},{"given":"Evelyn Yi Lyn","family":"Chee","sequence":"additional","affiliation":[{"name":"School of Computing, National University of Singapore , 117417, Singapore"}]},{"given":"Feng","family":"He","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute, Singapore National Eye Centre , 168751, Singapore"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0021-4861","authenticated-orcid":false,"given":"Cynthia Ciwei","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Singapore General Hospital , 168753, Singapore"}]},{"given":"Jinyi","family":"Ho","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute, Singapore National Eye Centre , 168751, Singapore"}]},{"given":"Haslina","family":"Hamzah","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute, Singapore National Eye Centre , 168751, Singapore"}]},{"given":"Ngiap Chuan","family":"Tan","sequence":"additional","affiliation":[{"name":"SingHealth Polyclinics, Singapore Health Services , 168582, 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Visual Science Academic Clinical Program, Duke-NUS Medical School , 169857, Singapore"}]},{"given":"Su Chi","family":"Lim","sequence":"additional","affiliation":[{"name":"Khoo Teck Puat Hospital , 768828, Singapore"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University , Singapore, 308232, Singapore"},{"name":"Saw Swee Hock School of Public Health, National University of Singapore , 117549, Singapore"}]},{"given":"Aaron Y","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Washington , Seattle, WA 98104, United States"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8448-1264","authenticated-orcid":false,"given":"Tien Yin","family":"Wong","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute, Singapore National Eye Centre , 168751, Singapore"},{"name":"Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School , 169857, 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