Ganesh Bushi, Abhay M. Gaidhane, Nasir Vadia, Soumya V. Menon, Kattela Chennakesavulu, Rajashree Panigrahi, Muhammed Shabil, Anju Rani, Sanjit Sah, Ambanna Yappalparvi, Khang Wen Goh, Diptismita Jena
Background: Proliferative diabetic retinopathy (PDR) is a sight-threatening complication of type 2 diabetes mellitus (T2DM), with limited tools available for early prediction. Serum creatinine, a marker of kidney function, may reflect shared microvascular pathology between diabetic nephropathy and retinopathy. However, its role in predicting PDR remains unclear. This review assessed the association between serum creatinine levels and the presence of PDR among patients with T2DM. Methods: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD42024595835). A comprehensive search was conducted in PubMed, Embase, and Web of Science up to October 3, 2024. Observational studies reporting serum creatinine levels in patients with PDR versus non-proliferative diabetic retinopathy (NPDR) or no diabetic retinopathy (non-DR) were included. Standardized mean differences (SMDs) were pooled using a random-effects model. Heterogeneity was assessed with the I2 statistic, and sensitivity analyses, meta-regression, and publication bias assessments were performed. Results: Eighteen studies involving 25,034 individuals were included. Serum creatinine levels were significantly higher in patients with PDR compared with non-DR (SMD, 0.97; 95% CI, 0.61–1.33; I2 = 95.7%) and NPDR (SMD, 0.46; 95% CI, 0.15–0.77; I2 = 82.7%). Sensitivity analyses confirmed the robustness of these findings. Meta-regression revealed no significant influence of HbA1c or diabetes duration on effect sizes. The association persisted despite high heterogeneity and potential publication bias. Conclusion: Elevated serum creatinine levels are significantly associated with the presence of PDR in patients with T2DM. Although creatinine may serve as a potential biomarker for identifying individuals at risk of PDR progression, further prospective, standardized studies are needed to validate its clinical utility. © The Author(s), under exclusive licence to Springer Nature B.V. 2025.
School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India; Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India; Marwadi University Research Center, Department of Pharmaceutical Sciences, Faculty of Health Sciences, Marwadi University, Gujarat, Rajkot, 360003, India; Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to Be University), Karnataka, Bangalore, India; Department of Chemistry, Sathyabama Institute of Science and Technology, Tamil Nadu, Chennai, India; Department of Microbiology, IMS and SUM Hospital, Siksha ‘O’ Anusandhan (Deemed to Be University), Odisha, Bhubaneswar, 751003, India; University Center for Research and Development, Chandigarh University, Punjab, Mohali, India; Medical Laboratories Techniques Department, AL-Mustaqbal University, Babil, Hillah, 51001, Iraq; Department of Microbiology, Graphic Era (Deemed to Be University), Clement Town, Dehra Dun, 248002, India; Department of Paediatrics, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed-to-Be-University), Maharashtra, Pimpri, Pune, 411018, India; Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth (Deemed-to-Be-University), Maharashtra, Pune, 411018, India; Department of Medicine, Korea Universtiy, Seoul, South Korea; Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India; Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia; Faculty of Mathematics and Natural Sciences, Universitas Negeri Padang, Padang, Indonesia; Centre for Research Impact and Outcome, Chitkara University Institute of Engineering and Technology, Chitkara University, Punjab, Rajpura, 140401, India; Division of Research and Innovation, Uttaranchal University, Dehra Dun, India
