Prakasini Satapathy, Abhay M. Gaidhane, Nasir Vadia, Soumya V. Menon, Kattela Chennakesavulu, Rajashree Panigrahi, Sanjit Sah, Ambana Yappalparvi, S. Govinda Rao, Khang Wen Goh, Rachana Mehta, Muhammed Shabil, Mahendra Singh, Edward Mawejje, Ganesh Bushi
Background: Proliferative diabetic retinopathy (PDR) is a serious vision-threatening complication of diabetes. Chronic kidney disease (CKD), measured by estimated glomerular filtration rate (eGFR), shares similar pathophysiological mechanisms with diabetic retinopathy, including inflammation, oxidative stress, and vascular dysfunction. However, the strength of the association between eGFR and PDR remains unclear. This review evaluates the association between reduced eGFR and the risk of PDR in individuals with diabetes. Methods: A comprehensive literature search was conducted in PubMed, Embase, and Web of Science, from inception to October 2024. Observational studies reporting both eGFR values and PDR status were included. Study quality was assessed using the Newcastle–Ottawa Scale. Pooled standardized mean differences (SMD) were calculated using a fixed-effects model when heterogeneity was low (I2 ≤ 50%). Subgroup analyses based on eGFR estimation method Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), sensitivity analyses, and meta-regression for diabetes duration and HbA1c were conducted. Publication bias was evaluated using funnel plots and Egger’s test. Results: A total of 11 studies were included, comprising 602 patients with PDR and 5,475 individuals without diabetic retinopathy. The pooled SMD for eGFR between PDR and non-PDR groups was − 0.43 (95% CI − 0.52 to − 0.34; P < 0.0001), indicating significantly lower eGFR in PDR patients. Heterogeneity was moderate (I2 = 42.3%). Subgroup analysis showed an SMD of − 0.58 (95% CI − 1.02 to − 0.14; I2 = 0%) using the MDRD formula and − 0.43 (95% CI − 0.58 to − 0.28; I2 = 80.4%) with the CKD-EPI formula. Meta-regression revealed a significant negative association between diabetes duration and PDR proportion (P = 0.0155), but no association with HbA1c (P = 0.7798). The prediction interval ranged from − 0.53 to − 0.33. Funnel plot asymmetry suggested potential publication bias (P < 0.05). Conclusions: This systematic review and meta-analysis found a significant association between reduced eGFR and PDR in patients with diabetes, with consistent findings across studies and eGFR estimation methods. Though heterogeneity suggests caution in interpretation. Additional prospective using standardized methodologies are needed to clarify causality and enhance risk prediction. © The Author(s), under exclusive licence to Springer Nature B.V. 2025.
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; 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; Department of Paediatrics, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed-to-be-University), Pimpri, Maharashtra, 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; 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, Dehradun, India; Department of Data Science, Gokaraju Rangaraju Institute of Engineering and Technology, Bachupally, Telangana, Hyderabad, 500090, India; Faculty of Mathematics and Natural Sciences, Universitas Negeri Padang, Padang, Indonesia; Clinical Microbiology, RDC, Manav Rachna International Institute of Research and Studies, Haryana, Faridabad, 121004, 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 Biotechnology, Graphic Era (Deemed to be University), Clement Town, Dehradun, 248002, India; Graphic Era Hill University, Clement Town, Dehradun, India; School of Public Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda; Chitkara Centre for Research and Development, Chitkara University Institute of Engineering and Technology, Chitkara University, Himachal Pradesh, Baddi, 174103, India; School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
