Prevalence of Diabetic Retinopathy and Associated Mortality Among Diabetic Adults With and Without Chronic Kidney Disease
Abstract
Purpose To estimate prevalence and severity of diabetic retinopathy (DR) among U.S. adults with diabetes and with or without chronic kidney disease (CKD), and assess associated risk of mortality. Design Cross-sectional study with national survey data. Methods The cohort included adults ≥40 years old with diabetes in the National Health and Nutrition Examination Surveys (NHANES) 2005-2008. Vital status was determined through December 31, 2011. We defined diabetes as hemoglobin A1c ≥6.5% or self-report and CKD by urinary albumin/creatinine ≥30 mg/g or glomerular filtration rate 2 . The main outcomes were DR and mortality. Results Prevalence of DR was 27.8% (95% CI 24.3-31.7), 36.2% (95%CI 30.1-42.7), and 23.4% (95% CI 19.2-28.1), overall, with and without CKD. Prevalence of vision-threatening DR was 4.2% (95% CI 3.2-5.5), 8.2% (95% CI 5.4-12.2), and 2.0% (95% CI 1.2-3.5), respectively. In a multivariable adjusted model, DR was positively but nonsignificantly associated with CKD (OR = 1.1, 95% CI 0.7-1.7), was 40% higher per 1% increase in hemoglobin A1c (OR = 1.4, 95% CI 1.1-1.6), was 30% higher per 5 years additional diabetes duration (OR = 1.3, 95% CI 1.1-1.5), was 30% higher per 10 mm Hg increase in systolic blood pressure (OR = 1.3, 95% CI 1.1-1.5), and was 6-fold higher with insulin treatment (OR = 6.2, 95% CI 2.6-14.8). Compared with diabetic participants with neither DR nor CKD, those with DR and CKD had a 3.6-fold (95% CI 1.5-9.1) increased adjusted risk for all-cause m…
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Patients diagnosed with hypertension are at higher risk for poor visual outcomes.
“Patients diagnosed with kidney disease, hypertension, and covered under Medicaid insurance are at higher risk for poor visual outcomes13–24.”
From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [18]
Patients diagnosed with kidney disease are at higher risk for poor visual outcomes.
“Patients diagnosed with kidney disease, hypertension, and covered under Medicaid insurance are at higher risk for poor visual outcomes13–24.”
From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [18]
Patients covered under Medicaid insurance are at higher risk for poor visual outcomes.
“Patients diagnosed with kidney disease, hypertension, and covered under Medicaid insurance are at higher risk for poor visual outcomes13–24.”
From Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients (2026) · cites this paper as [18]
Cites
Prevalence of Diabetic Retinopathy in the United States, 2005-2008
Zhang, X., Saaddine, J. B., Chou, C.-F., Cotch, M. F., Cheng, Y. J., Geiss, L. S., Gregg, E. W., Albright, A. L., Klein, B. E. K., & Klein, R. (2010) · JAMA · doi:10.1001/jama.2010.1111 · Cited by 1,196 · see citing works
Self-citationDiabetic kidney disease: a report from an ADA Consensus Conference
Tuttle, K. R., Bakris, G. L., Bilous, R. W., Chiang, J. L., de Boer, I. H., Goldstein-Fuchs, J., Hirsch, I. B., Kalantar-Zadeh, K., Narva, A. S., Navaneethan, S. D., et al. (2014) · Diabetes Care · doi:10.2337/dc14-1296 · Cited by 1,153 · see citing works
Kramer, H. J. (2003) · JAMA · doi:10.1001/jama.289.24.3273 · Cited by 618 · see citing works
He, F., Xia, X., Wu, X. F., Yu, X. Q., & Huang, F. X. (2013) · Diabetologia · doi:10.1007/s00125-012-2796-6 · Cited by 228 · see citing works
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Leong, A., Wolf, R. M., Channa, R., Wang, J., Lehmann, H., Abramoff, M. D., & Liu, T. Y. A. (2026) · npj Digital Medicine · doi:10.1038/s41746-026-02460-5 · Cited by 3 · see citing works
- Authors
- Pavkov, M. E., Harding, J. L., Chou, C.-F., & Saaddine, J. B.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Pavkov, Meda E.
- Venue
- American Journal of Ophthalmology
- Publisher
- Elsevier BV
- Published
- 2019-02
- Volume
- 198
- Pages
- 200-208
- ISSN
- 0002-9394 (ISSN-L)
- OpenAlex
- W2898501420
- Cited by
- 31
- References
- 4
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 7 · 2023: 3 · 2022: 6 · 2021: 8 · 2020: 1
- FWCI
- 2.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- diabetic retinopathy, chronic kidney disease, diabetes mellitus, prevalence, mortality, vision-threatening retinopathy, HbA1c, diabetes duration, systolic blood pressure, insulin therapy, albuminuria, glomerular filtration rate, risk factors, NHANES, adults with diabetes, comorbidities, retinopathy severity, retinopathy progression, retinopathy regression
- MeSH terms
- Aged, Albuminuria, Blood Pressure, Creatinine, Cross-Sectional Studies, Diabetes Mellitus, Diabetic Retinopathy, Female, Glomerular Filtration Rate, Glycated Hemoglobin, Humans, Male, Middle Aged, Nutrition Surveys, Risk Factors, United States, Prevalence, Renal Insufficiency, Chronic
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