{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T06:09:40Z","timestamp":1789711780800,"version":"4.0.1"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To determine whether chronic kidney disease (CKD) severity is associated with progression from nonproliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) and severe retinal complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>In this retrospective TriNetX cohort study, adults with Type 2 diabetes and NPDR were matched 1:1 by CKD stage (1\u20132, 3, 4\u20135 or end\u2010stage renal disease [ESRD]) to patients without CKD. Patients with prior PDR, diabetic macular oedema, intravitreal treatment, or vitrectomy were excluded. Cox models estimated 3\u2010year hazard ratios (HRs) for PDR and a composite of PDR, vitreous haemorrhage, tractional retinal detachment or vitrectomy. Sensitivity analyses used laboratory\u2010defined estimated glomerular filtration rate and cohorts restricted to mild NPDR or documented baseline haemoglobin A1c.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Matched comparisons included 8476, 24\u2009432, 9933 and 7359 patients with CKD Stages 1\u20132, 3, 4\u20135 and ESRD, respectively, with equal\u2010sized reference cohorts. PDR risk increased with CKD severity: HR 1.12 (95% confidence interval [CI] 0.96\u20131.29) for Stages 1\u20132, 1.35 (1.23\u20131.47) for Stage 3, 1.59 (1.40\u20131.80) for Stages 4\u20135 and 1.66 (1.45\u20131.89) for ESRD. Similar associations were observed for the composite and persisted in laboratory\u2010defined and mild\u2010NPDR\u2010restricted analyses, although residual baseline haemoglobin A1c imbalance remained in advanced CKD comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CKD Stage 3 or higher was associated with greater progression from NPDR to PDR and severe retinal complications. CKD severity may identify higher\u2010risk patients, although prospective studies are needed before CKD\u2010specific surveillance is recommended.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.71368","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:41:30Z","timestamp":1789710090000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Chronic Kidney Disease Severity and Progression to Proliferative Diabetic Retinopathy"],"prefix":"10.1111","author":[{"given":"Taemin","family":"Kim","sequence":"first","affiliation":[{"name":"The Warren Alpert Medical School Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anh","family":"Vu","sequence":"additional","affiliation":[{"name":"Department of Health and Clinical Outcome Research Saint Louis University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zara","family":"Ali","sequence":"additional","affiliation":[{"name":"The Warren Alpert Medical School Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Massachusetts Eye and Ear Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0794-1263","authenticated-orcid":false,"given":"Chien\u2010Hsiang","family":"Weng","sequence":"additional","affiliation":[{"name":"Brown University Health  Providence Rhode Island USA"},{"name":"Department of Family Medicine Warren Alpert Medical School of Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc26\u2010S012"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2024.12.020"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161\u20106420(03)00475\u20105"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11892\u2010021\u201001396\u20102"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.816400"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc11\u20101955"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0220506"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc12\u20100790"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/(sici)1097\u20100258(19981015)17:19<2265::aid\u2010sim918>3.0.co;2\u2010b"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/pst.433"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3697"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaophthalmol.2017.5202"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/8784139"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2017.05.020"},{"issue":"2","key":"e_1_2_9_16_1","first-page":"233","article-title":"Risk Factors for High\u2010Risk Proliferative Diabetic Retinopathy and Severe Visual Loss: Early Treatment Diabetic Retinopathy Study Report #18","volume":"39","author":"Davis M. 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