{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:22:50Z","timestamp":1786116170594,"version":"build-2736575974"},"reference-count":24,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Diabetic retinopathy (DR) is the most prevalent microvascular complication of type 2 diabetes mellitus (T2DM) and a recognised marker of systemic vascular injury. Whether DR\u2014graded independently by two experienced ophthalmologists as part of routine institutional care\u2014is independently associated with concurrent nephropathy (urine albumin-to-creatinine ratio [UACR] \u2265 30 mg\/g) and subclinical cardiac stress (N-terminal pro-B-type natriuretic peptide [NT-proBNP] \u2265 125 pg\/mL) remains insufficiently examined. Methods: Retrospective cross-sectional study of 401 T2DM adults who underwent dilated fundus examination independently graded by two board-certified ophthalmologists (each \u2265 10 years\u2019 experience in diabetic eye disease) using ETDRS-based classification. Inter-physician agreement was quantified by Cohen\u2019s weighted kappa. The primary composite outcome was concurrent nephropathy and subclinical cardiac stress. Multivariable logistic regression adjusted for age, sex, HbA1c, diabetes duration, eGFR, hypertension, and pharmacological treatments. Results: The composite outcome was present in 120 (64.2%) DR-positive vs. 14 (6.5%) DR-negative patients (crude OR: 25.59 (13.78\u201347.51); p &lt; 0.001; fully adjusted OR: 21.49 (11.02\u201341.81); p &lt; 0.001). Inter-physician agreement was high (Cohen\u2019s weighted \u03ba = 0.88; 95% CI: 0.83\u20130.93). Nephropathy alone was found in 164 (87.7%) vs. 76 (35.5%) patients (OR: 12.95 (7.71\u201321.75); p &lt; 0.001), and elevated NT-proBNP in 137 (73.3%) vs. 39 (18.2%) patients (OR: 12.29 (7.65\u201319.76); p &lt; 0.001). A significant trend across DR severity grades was observed (p for trend &lt; 0.001), although the gradient was not strictly monotonic. ROC AUC = 0.837 (95% CI: 0.784\u20130.860). Conclusions: Ophthalmologist-graded DR was independently associated with the concurrent presence of albuminuria and elevated NT-proBNP in T2DM. Because the design is cross-sectional, these findings describe association rather than prediction or causation. They generate the hypothesis that retinal grading may help flag patients in whom cardiorenal biomarker assessment is worth considering, but prospective validation is required before any screening application.<\/jats:p>","DOI":"10.3390\/jcm15156106","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T08:08:02Z","timestamp":1786003682000},"page":"6106","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diabetic Retinopathy Grading and Concurrent Cardiorenal Biomarker Abnormalities in Type 2 Diabetes: Albuminuria and Elevated NT-proBNP\u2014A Retrospective Cross-Sectional Study"],"prefix":"10.3390","volume":"15","author":[{"given":"\u0130rfan","family":"Alisan","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Health Sciences, Adana Health Practice and Research Center, Adana 01230, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet Gazi","family":"Mustan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Health Sciences, Adana Health Practice and Research Center, Adana 01230, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9553-722X","authenticated-orcid":false,"given":"Bektas","family":"Isik","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Health Sciences, Adana Health Practice and Research Center, Adana 01230, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatih Necip","family":"Ar\u0131c\u0131","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Health Sciences, Adana Health Practice and Research Center, Adana 01230, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cahit","family":"Din\u00e7er","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Health Sciences, Adana Health Practice and Research Center, Adana 01230, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c7isem","family":"Y\u0131lmaz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Health Sciences, Adana Health Practice and Research Center, Adana 01230, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8665-152X","authenticated-orcid":false,"given":"Mehmet","family":"Erdevir","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Yuregir State Hospital, Adana 01240, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0360-2605","authenticated-orcid":false,"given":"Ahmet","family":"Alt\u0131nta\u015f","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Health Sciences, Osmaniye Health Practice and Research Center, Osmaniye 80010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c7i\u011fdem","family":"Erhan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seyhan State Hospital, Adana 01150, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2420-1002","authenticated-orcid":false,"given":"Merve","family":"Saracoglu Sumbul","sequence":"additional","affiliation":[{"name":"Department of Public Health, Adana City Research and Training Hospital, Adana 01230, 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University of Health Sciences, Adana Health Practice and Research Center, Adana 01230, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7192-0280","authenticated-orcid":false,"given":"Hilmi Erdem","family":"Sumbul","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Health Sciences, Adana Health Practice and Research Center, Adana 01230, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1177\/2047487319878371","article-title":"Diabetes as a cardiovascular risk factor: An overview of global trends of macro and micro vascular complications","volume":"26","author":"Ceriello","year":"2019","journal-title":"Eur. 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