Retinal Vessel Diameters and the Incidence of Gross Proteinuria and Renal Insufficiency in People With Type 1 Diabetes

  1. Tien Yin Wong, 12,
  2. Anoop Shankar3,
  3. Ronald Klein3 and
  4. Barbara E.K. Klein3
  1. 1Centre for Vision Research, University of Melbourne, Melbourne, Australia
  2. 2Department of Ophthalmology, National University of Singapore, Eye Research Institute, Singapore
  3. 3Department of Ophthalmology, University of Wisconsin, Madison, Wisconsin
  1. Address correspondence and reprint requests to Tien Yin Wong, MD, PhD, Centre for Eye Research Australia, Department of Ophthalmology, University of Melbourne, 32 Gisborne St., East Melbourne 3002, Australia. E-mail: ophwty{at}


Early retinal vessel caliber changes may predict risk of diabetic nephropathy. We examined the association of retinal vessel diameters and the incidence of gross proteinuria and renal insufficiency in a population-based cohort of people with type 1 diabetes (n = 557). Baseline retinal photographs were digitized, and diameters of individual retinal vessels were measured and summarized. Incident cases of gross proteinuria and renal insufficiency were identified over a 16-year period. Larger retinal venular diameter was associated with higher cumulative incidence of gross proteinuria (18.6, 25.4, 37.7, and 50.4%, comparing increasing venular diameter quartiles) and renal insufficiency (10.7, 15.5, 23.2, and 32.8%). After adjusting for age, sex, duration of diabetes, HbA1c levels, baseline retinopathy levels, and other factors, larger retinal venular diameter was associated with an increased risk of gross proteinuria (RR 1.53, 95% CI 1.19–1.97, comparing 4th vs. 1st to 3rd quartiles of venular diameter) and renal insufficiency (1.51, 1.05–2.17). Retinal arteriolar diameter was not associated with either gross proteinuria or renal insufficiency. We conclude that in individuals with type 1 diabetes, larger retinal venular diameter is independently associated with the long-term incidence of gross proteinuria and renal insufficiency and may provide additional predictive information regarding risk of nephropathy.


    • Accepted October 6, 2003.
    • Received May 19, 2003.
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