{"doi":"10.34067/kid.0003752022","title":"Seeing the Light: Improving Diabetic Retinopathy Outcomes by Bringing Screening to the Dialysis Clinic","abstract":"Diabetic retinopathy (DR) is the leading cause of preventable blindness in the developed world, with an estimated 103 million people (22% of all people with diabetes) affected by DR (1). With the rapidly increasing worldwide prevalence of diabetes, this number is projected to rise to 160 million by 2045, along with a concomitant rise in other microvascular diseases such as diabetic nephropathy (1,2). In 2019, nearly half of all new dialysis-dependent kidney failure cases were attributed to diabetes, and more than two-thirds of people treated with dialysis had comorbid diabetes (3,4). Small studies suggest that >70% of people receiving dialysis who have comorbid diabetes have DR (5). Annual eye examinations, at a minimum, are considered standard of care for all people with diabetes because early detection, treatment, and regular follow-up of DR can prevent blindness (6,7). Since the early 2000s, there has been robust uptake of DR screening programs worldwide, driving 2019 screening rates to >80% in the United Kingdom and >70% in Denmark (8,9). Screening rates in the United States are lower, with just 65% of individuals with diabetes undergoing annual DR screening in 2019 (10). Although limited global data are available, patients with dialysis-dependent kidney failure fair worse: estimates suggest that <50% of Canadian hemodialysis patients and <60% of Japanese hemodialysis patients have up-to-date eye examinations (11,12). Barriers such as the burdensome nature of thrice-weekly hemodialysis, competing medical priorities, limited personal resources, and lack of awareness of their elevated risk of DR progression likely contribute to these poor DR screening rates. Performing routine foot checks at dialysis clinics has been shown to reduce the risk of major lower-limb amputations in patients with comorbid diabetes (13), but to date, there has been less emphasis on DR screening. Bringing additional aspects of diabetes-related care to the patient at the dialysis clinic has the potential to improve diabetes-related morbidity and mortality meaningfully, including DR outcomes, among people receiving hemodialysis. In this issue of Kidney360, Cushley et al. describe adherence to annual DR screening in patients receiving hemodialysis and examine the severity of retinopathy detected via a screening program instituted at hemodialysis clinics in Northern Ireland (14). All patients receiving hemodialysis with comorbid diabetes were invited to participate in the DR screening program, and 132 (89%) of eligible patients enrolled and attended screening. Unsurprisingly, screening rates before implementation of the dialysis clinic–based screening program were low, with 34% of individuals having no screening eye examination within 3 years and 15% of individuals never having a screening. However, the results of the dialysis clinic–based DR screenings were striking. Of the 132 enrolled patients, 17 (13%) required urgent referral to hospital eye services—a staggering proportion compared with the Irish national average of 0.4%. Although this report does have limitations (e.g., modest sample size and limited data on participant comorbid disease severity, glycemic control, and duration of diabetes), as acknowledged by the authors, these findings are sobering. Moreover, they align with reports from other countries showing poor DR screening rates among individuals receiving dialysis. For example, another recent Kidney360 publication examining gaps in care among patients receiving maintenance in-center hemodialysis in Canada between 2016 and 2018 found that 53% of patients had no evidence of annual DR screening (11). Given the poor adherence to DR screening in the general United States diabetes population, it is likely that screening rates among people receiving dialysis in the United States are even more dismal. These data, along with evidence suggesting that such gaps in diabetes care are not limited to annual eye exams (11), highlight the vulnerability of ","journal":"Kidney360","year":2022,"id":290458,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9449,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":241192,"name":"Jennifer E. Flythe","orcid":"0000-0003-4596-8536","position":1,"is_corresponding":false},{"id":506669,"name":"Klara R. Klein","orcid":"0000-0002-5894-9054","position":0,"is_corresponding":true}],"reference_count":26,"raw_metadata":null,"created_at":"2026-07-19T00:30:30.639224Z","pmid":"36245657","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}