{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T14:10:42Z","timestamp":1778767842070,"version":"3.51.4"},"reference-count":23,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001349","name":"Singapore Ministry of Health\u2019s National Medical Research Council","doi-asserted-by":"publisher","award":["NMRC\/HCSAINV\/MOH-001019-00"],"award-info":[{"award-number":["NMRC\/HCSAINV\/MOH-001019-00"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001349","name":"Singapore Ministry of Health\u2019s National Medical Research Council","doi-asserted-by":"publisher","award":["NMRC\/OFLCG\/MOH-001327-03"],"award-info":[{"award-number":["NMRC\/OFLCG\/MOH-001327-03"]}],"id":[{"id":"10.13039\/501100001349","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Cystatin C-based and combined creatinine\u2013cystatin C estimated glomerular filtration rate (eGFR) equations improve early chronic kidney disease (CKD) detection and prediction of adverse outcomes compared to creatinine alone. However, their role in predicting microvascular complications such as diabetic retinopathy (DR) is less clear. We examined the association between diabetic kidney disease (DKD), defined using creatinine-, cystatin C-, and combined eGFR measures, as well as albuminuria, and the risk of incident DR among Asian adults in Singapore. Methods: We analysed 1135 Chinese and Indian adults with diabetes aged \u226540 years from a population-based cohort study with baseline (2007\u20132011) and 6-year follow-up (2013\u20132017) data. DR was graded from retinal photographs, and incident DR was defined as new-onset at follow-up. DKD was defined as eGFR &lt; 60 mL\/min\/1.73 m2 using eGFRcr, eGFRcys, combined eGFRcr-cys, and albuminuria (UACR \u2265 30 mg\/g), assessed individually and jointly. Modified Poisson regression models adjusted for age, sex, ethnicity, diabetes duration, HbA1c, and systolic blood pressure were used to estimate relative risks (RRs). Results: Overall, incident DR occurred in 13.0% of participants. Among those with DKD, incidence was 18.2% (eGFRcr), 16.7% (eGFRcys), 23.7% (eGFRcr-cys), and 18.3% (albuminuria). eGFRcr-DKD (RR = 2.18, 95% CI 1.33\u20133.58), eGFRcys-DKD (2.38 [1.51\u20133.78]), and eGFRcr-cys-DKD (3.15 [1.94\u20135.12]) were independently associated with incident DR, whereas albuminuria alone was not. Risk increased with increasing number of markers,2.00 (1.02\u20133.92) by dual and 4.91 (2.50\u20139.65) by triple markers. Conclusions: DKD defined using multiple kidney markers, particularly combined creatinine\u2013cystatin C, was strongly associated with incident DR. These findings support the use of multiple kidney function markers to improve risk stratification for developing DR.<\/jats:p>","DOI":"10.3390\/diagnostics16101492","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:04:09Z","timestamp":1778763849000},"page":"1492","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multi-Marker Detection of Diabetic Kidney Disease and Risk of Incident Diabetic Retinopathy in a Multi-Ethnic Asian Population"],"prefix":"10.3390","volume":"16","author":[{"given":"Guan Hui","family":"Yap","sequence":"first","affiliation":[{"name":"Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barry Moses Quan Ren","family":"Koh","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miao Li","family":"Chee","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riswana","family":"Banu","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sieh Yean","family":"Kiew","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cynthia Ciwei","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Singapore General Hospital, Singapore 169856, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gavin","family":"Tan","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore"},{"name":"Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ching-Yu","family":"Cheng","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4042-4719","authenticated-orcid":false,"given":"Charumathi","family":"Sabanayagam","sequence":"additional","affiliation":[{"name":"Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 169856, Singapore"},{"name":"Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref_1","unstructured":"International Diabetes Federation (IDF) (2015). 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Nephrol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/10\/1492\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:21:16Z","timestamp":1778764876000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/10\/1492"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":23,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16101492"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16101492","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]}}}