ERA 2024, 22 May 2024



We had previously developed a deep-learning-based risk evaluation system from retinal
photographs, Reti-CKD, for stratifying chronic kidney (CKD) development risk in kidney function
preserved people. This study aims to evaluate whether Reti-CKD can improve risk assessment
of kidney disease progression in diabetic patients with prevalent CKD.


Total of 5348 diabetic patients from two tertiary hospitals in Korea were evaluated. Patients
with estimated glomerular filtration rate (eGFR) <90 ml/min/1.73m2
or albuminuria were included. Those with missing data for retinal photograph, serum creatinine, or albuminuria were excluded. Patients were categorized into low-risk, moderate-risk, and high-risk groups according
to the KDIGO criteria for prognosis of CKD. The KDIGO groups were additionally dichotomized
based on Reti-CKD score (Reti-CKD <20 and ≥20). CKD progression was compared between
the categories using Cox regression models. Primary outcome was CKD progression, defined as
incremental progression to a higher NKF-KDOQI CKD stage.


The mean age of the patients was 62.4 ± 11.4 years and 60.6% were male. Mean eGFR was
86.6 ± 15.3 mL/min per 1.73 m2 and albuminuria was present in 46.9%. During a median
follow-up of 5.0 (interquartile range, 2.5-7.8) years, primary outcome developed in 1379
(25.8%) patients. The primary outcome incidence rate gradually increased with higher KDIGO
and Reti-CKD combined risk categories. The risk for CKD progression progressively increased in
KDIG moderate-risk and high-risk groups compared to low-risk. When Reti-CKD was
incorporated to the KDIGO category, significant stratification of CKD progression risk was noted
in the KDIGO low-risk and moderate-risk groups (Table and Figure). Additionally, the
combination of KDIGO and Reti-CKD classification showed better discrimination power
compared to the KDIGO only classification (delta c-statistics, 0.03; 95% CI 0.02 to 0.040).


Retinal photography-based deep learning system (Reti-CKD) further stratifies the risk of CKD progression and improves predictability in diabetic patients with reduced renal function.