Non-invasive biopsy diagnosis of diabetic kidney disease via deep learning applied to retinal images: a population-based study
Summary: Background: Improving the accessibility of screening diabetic kidney disease (DKD) and differentiating isolated diabetic nephropathy from non-diabetic kidney disease (NDKD) are two major challenges in the field of diabetes care. We aimed to develop and validate an artificial intelligence (...
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2025-05-01
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| Series: | The Lancet: Digital Health |
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| author | Ziyao Meng, MEng Zhouyu Guan, MD Shujie Yu, MBBS Yilan Wu, BSc Yaoning Zhao, BSc Jie Shen, PhD Cynthia Ciwei Lim, MMed Tingli Chen, MD Dawei Yang, PhD An Ran Ran, PhD Feng He, MSc Haslina Hamzah, BSc Sarkaaj Singh, MSc Anis Syazwani Abd Raof, MSc Jian Wen Samuel Lee-Boey, MBBS ProfMBBS Soo-Kun Lim, MBBS ProfMD Xufang Sun, MBBS Shuwang Ge, MD ProfMD Gang Xu, MD Prof Hua Su, MD Yang Cheng, MD Feng Lu, PhD ProfPhD Xiaofei Liao, PhD ProfPhD Hai Jin, PhD Chenxin Deng, MMed Lei Ruan, MD ProfMD Cuntai Zhang, MD Chan Wu, MD ProfMD Rongping Dai, MD Yixiao Jin, MSc Wenxiao Wang, PhD Tingyao Li, BSc Ruhan Liu, PhD Jiajia Li, PhD Jia Shu, BEng Yuwei Lu, MBBS Xiangning Wang, MD Qiang Wu, MD Yiming Qin, BEng Jin Tang, MD Xiaohua Sheng, MD Qiong Jiao, MD ProfPhD Xiaokang Yang, MD ProfPhD Minyi Guo, MD Gareth J McKay, PhD ProfPhD Ruth E Hogg, PhD Gerald Liew, MBBS Evelyn Yi Lyn Chee, PhD ProfPhD Wynne Hsu, PhD ProfPhD Mong Li Lee, PhD Simon Szeto, MBChB ProfMD Andrea O Y Luk, MBChB ProfMD Juliana C N Chan, MBChB Carol Y Cheung, PhD Gavin Siew Wei Tan, FRCSEd Yih-Chung Tham, PhD ProfMD PhD Ching-Yu Cheng, PhD Charumathi Sabanayagam, MD PhD ProfPhD Lee-Ling Lim, MD PhD ProfMD PhD Weiping Jia, MD PhD ProfMD PhD Huating Li, MD PhD Bin Sheng, Prof Tien Yin Wong, Prof |
| author_facet | Ziyao Meng, MEng Zhouyu Guan, MD Shujie Yu, MBBS Yilan Wu, BSc Yaoning Zhao, BSc Jie Shen, PhD Cynthia Ciwei Lim, MMed Tingli Chen, MD Dawei Yang, PhD An Ran Ran, PhD Feng He, MSc Haslina Hamzah, BSc Sarkaaj Singh, MSc Anis Syazwani Abd Raof, MSc Jian Wen Samuel Lee-Boey, MBBS ProfMBBS Soo-Kun Lim, MBBS ProfMD Xufang Sun, MBBS Shuwang Ge, MD ProfMD Gang Xu, MD Prof Hua Su, MD Yang Cheng, MD Feng Lu, PhD ProfPhD Xiaofei Liao, PhD ProfPhD Hai Jin, PhD Chenxin Deng, MMed Lei Ruan, MD ProfMD Cuntai Zhang, MD Chan Wu, MD ProfMD Rongping Dai, MD Yixiao Jin, MSc Wenxiao Wang, PhD Tingyao Li, BSc Ruhan Liu, PhD Jiajia Li, PhD Jia Shu, BEng Yuwei Lu, MBBS Xiangning Wang, MD Qiang Wu, MD Yiming Qin, BEng Jin Tang, MD Xiaohua Sheng, MD Qiong Jiao, MD ProfPhD Xiaokang Yang, MD ProfPhD Minyi Guo, MD Gareth J McKay, PhD ProfPhD Ruth E Hogg, PhD Gerald Liew, MBBS Evelyn Yi Lyn Chee, PhD ProfPhD Wynne Hsu, PhD ProfPhD Mong Li Lee, PhD Simon Szeto, MBChB ProfMD Andrea O Y Luk, MBChB ProfMD Juliana C N Chan, MBChB Carol Y Cheung, PhD Gavin Siew Wei Tan, FRCSEd Yih-Chung Tham, PhD ProfMD PhD Ching-Yu Cheng, PhD Charumathi Sabanayagam, MD PhD ProfPhD Lee-Ling Lim, MD PhD ProfMD PhD Weiping Jia, MD PhD ProfMD PhD Huating Li, MD PhD Bin Sheng, Prof Tien Yin Wong, Prof |
| author_sort | Ziyao Meng, MEng |
| collection | DOAJ |
| description | Summary: Background: Improving the accessibility of screening diabetic kidney disease (DKD) and differentiating isolated diabetic nephropathy from non-diabetic kidney disease (NDKD) are two major challenges in the field of diabetes care. We aimed to develop and validate an artificial intelligence (AI) deep learning system to detect DKD and isolated diabetic nephropathy from retinal fundus images. Methods: In this population-based study, we developed a retinal image-based AI-deep learning system, DeepDKD, pretrained using 734 084 retinal fundus images. First, for DKD detection, we used 486 312 retinal images from 121 578 participants in the Shanghai Integrated Diabetes Prevention and Care System for development and internal validation, and ten multi-ethnic datasets from China, Singapore, Malaysia, Australia, and the UK (65 406 participants) for external validation. Second, to differentiate isolated diabetic nephropathy from NDKD, we used 1068 retinal images from 267 participants for development and internal validation, and three multi-ethnic datasets from China, Malaysia, and the UK (244 participants) for external validation. Finally, we conducted two proof-of-concept studies: a prospective real-world study with 3 months' follow-up to evaluate the effectiveness of DeepDKD in screening DKD; and a longitudinal analysis of the effectiveness of DeepDKD in differentiating isolated diabetic nephropathy from NDKD on renal function changes with 4·6 years' follow-up. Findings: For detecting DKD, DeepDKD achieved an area under the receiver operating characteristic curve (AUC) of 0·842 (95% CI 0·838–0·846) on the internal validation dataset and AUCs of 0·791–0·826 across external validation datasets. For differentiating isolated diabetic nephropathy from NDKD, DeepDKD achieved an AUC of 0·906 (0·825–0·966) on the internal validation dataset and AUCs of 0·733–0·844 across external validation datasets. In the prospective study, compared with the metadata model, DeepDKD could detect DKD with higher sensitivity (89·8% vs 66·3%, p<0·0001). In the longitudinal study, participants with isolated diabetic nephropathy and participants with NDKD identified by DeepDKD had a significant difference in renal function outcomes (proportion of estimated glomerular filtration rate decline: 27·45% vs 52·56%, p=0·0010). Interpretation: Among diverse multi-ethnic populations with diabetes, a retinal image-based AI-deep learning system showed its potential for detecting DKD and differentiating isolated diabetic nephropathy from NDKD in clinical practice. Funding: National Key R & D Program of China, National Natural Science Foundation of China, Beijing Natural Science Foundation, Shanghai Municipal Key Clinical Specialty, Shanghai Research Centre for Endocrine and Metabolic Diseases, Innovative research team of high-level local universities in Shanghai, Noncommunicable Chronic Diseases-National Science and Technology Major Project, Clinical Special Program of Shanghai Municipal Health Commission, and the three-year action plan to strengthen the construction of public health system in Shanghai. |
| format | Article |
| id | doaj-art-ae5128210fc84ef4b71df992d964e817 |
| institution | OA Journals |
| issn | 2589-7500 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet: Digital Health |
| spelling | doaj-art-ae5128210fc84ef4b71df992d964e8172025-08-20T02:17:19ZengElsevierThe Lancet: Digital Health2589-75002025-05-017510086810.1016/j.landig.2025.02.008Non-invasive biopsy diagnosis of diabetic kidney disease via deep learning applied to retinal images: a population-based studyZiyao Meng, MEng0Zhouyu Guan, MD1Shujie Yu, MBBS2Yilan Wu, BSc3Yaoning Zhao, BSc4Jie Shen, PhD5Cynthia Ciwei Lim, MMed6Tingli Chen, MD7Dawei Yang, PhD8An Ran Ran, PhD9Feng He, MSc10Haslina Hamzah, BSc11Sarkaaj Singh, MSc12Anis Syazwani Abd Raof, MSc13Jian Wen Samuel Lee-Boey, MBBS14ProfMBBS Soo-Kun Lim, MBBS15ProfMD Xufang Sun, MBBS16Shuwang Ge, MD17ProfMD Gang Xu, MD18Prof Hua Su, MD19Yang Cheng, MD20Feng Lu, PhD21ProfPhD Xiaofei Liao, PhD22ProfPhD Hai Jin, PhD23Chenxin Deng, MMed24Lei Ruan, MD25ProfMD Cuntai Zhang, MD26Chan Wu, MD27ProfMD Rongping Dai, MD28Yixiao Jin, MSc29Wenxiao Wang, PhD30Tingyao Li, BSc31Ruhan Liu, PhD32Jiajia Li, PhD33Jia Shu, BEng34Yuwei Lu, MBBS35Xiangning Wang, MD36Qiang Wu, MD37Yiming Qin, BEng38Jin Tang, MD39Xiaohua Sheng, MD40Qiong Jiao, MD41ProfPhD Xiaokang Yang, MD42ProfPhD Minyi Guo, MD43Gareth J McKay, PhD44ProfPhD Ruth E Hogg, PhD45Gerald Liew, MBBS46Evelyn Yi Lyn Chee, PhD47ProfPhD Wynne Hsu, PhD48ProfPhD Mong Li Lee, PhD49Simon Szeto, MBChB50ProfMD Andrea O Y Luk, MBChB51ProfMD Juliana C N Chan, MBChB52Carol Y Cheung, PhD53Gavin Siew Wei Tan, FRCSEd54Yih-Chung Tham, PhD55ProfMD PhD Ching-Yu Cheng, PhD56Charumathi Sabanayagam, MD PhD57ProfPhD Lee-Ling Lim, MD PhD58ProfMD PhD Weiping Jia, MD PhD59ProfMD PhD Huating Li, MD PhD60Bin Sheng, Prof61Tien Yin Wong, Prof62Shanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Institute for Proactive Healthcare, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Centre for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China; MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Institute for Proactive Healthcare, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Centre for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, ChinaShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Institute for Proactive Healthcare, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Centre for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, ChinaBeijing Visual Science and Translational Eye Research Institute (BERI), Beijing Tsinghua Changgung Hospital Eye Center, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, ChinaBeijing Visual Science and Translational Eye Research Institute (BERI), Beijing Tsinghua Changgung Hospital Eye Center, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, ChinaMedical Records and Statistics Office, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Renal Medicine, Singapore General Hospital, SingHealth-Duke Academic Medical Centre, Singapore, SingaporeDepartment of Ophthalmology, Shanghai Health and Medical Center, Wuxi, ChinaDepartment of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaDepartment of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaSingapore Eye Research Institute, Singapore National Eye Centre, SingaporeSingapore Eye Research Institute, Singapore National Eye Centre, SingaporeDepartment of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MalaysiaDepartment of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MalaysiaDepartment of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MalaysiaDepartment of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, MalaysiaDepartment of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, ChinaDepartment of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaNational Engineering Research Centre for Big Data Technology and System, Services Computing Technology and System Laboratory, Cluster and Grid Computing Laboratory, School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, ChinaNational Engineering Research Centre for Big Data Technology and System, Services Computing Technology and System Laboratory, Cluster and Grid Computing Laboratory, School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, ChinaNational Engineering Research Centre for Big Data Technology and System, Services Computing Technology and System Laboratory, Cluster and Grid Computing Laboratory, School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaDepartment of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, ChinaDepartment of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, ChinaBeijing Visual Science and Translational Eye Research Institute (BERI), Beijing Tsinghua Changgung Hospital Eye Center, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, ChinaKey Laboratory of River Basic Digital Twinning of Ministry of Water Resources, Macau University of Science and Technology, Macau Special Administrative Region, ChinaShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Institute for Proactive Healthcare, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Centre for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China; MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Institute for Proactive Healthcare, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Centre for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China; MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Institute for Proactive Healthcare, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Centre for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China; MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Institute for Proactive Healthcare, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Centre for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China; MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Institute for Proactive Healthcare, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Centre for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, ChinaDepartment of Ophthalmology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Ophthalmology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Institute for Proactive Healthcare, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Centre for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China; MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Clinical Laboratory, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Nephrology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Pathology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaMOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Institute for Proactive Healthcare, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Centre for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China; MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, ChinaCentre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, UKCentre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Belfast, UKWestmead Institute for Medical Research, University of Sydney, NSW, AustraliaSchool of Computing, National University of Singapore, SingaporeSchool of Computing, National University of Singapore, SingaporeSchool of Computing, National University of Singapore, SingaporeDepartment of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaDepartment of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, ChinaDepartment of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, ChinaDepartment of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, ChinaSingapore Eye Research Institute, Singapore National Eye Centre, SingaporeSingapore Eye Research Institute, Singapore National Eye Centre, Singapore; Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, SingaporeSingapore Eye Research Institute, Singapore National Eye Centre, Singapore; Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, SingaporeSingapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, SingaporeDepartment of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, ChinaShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Institute for Proactive Healthcare, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Centre for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, ChinaShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Institute for Proactive Healthcare, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Centre for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China; Prof Huating Li, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Centre for Diabetes, Shanghai 200233, ChinaShanghai Belt and Road International Joint Laboratory of Intelligent Prevention and Treatment for Metabolic Diseases, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Institute for Proactive Healthcare, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Centre for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China; MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China; Prof Bin Sheng, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, ChinaBeijing Visual Science and Translational Eye Research Institute (BERI), Beijing Tsinghua Changgung Hospital Eye Center, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Beijing Key Laboratory of Intelligent Diagnostic Technology and Devices for Major Blinding Eye Diseases, Tsinghua Medicine, Tsinghua University, Beijing, China; Correspondence to: Prof Tien Yin Wong, Beijing Visual Science and Translational Eye Research Institute (BERI), Beijing Tsinghua Changgung Hospital Eye Center, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 100084, ChinaSummary: Background: Improving the accessibility of screening diabetic kidney disease (DKD) and differentiating isolated diabetic nephropathy from non-diabetic kidney disease (NDKD) are two major challenges in the field of diabetes care. We aimed to develop and validate an artificial intelligence (AI) deep learning system to detect DKD and isolated diabetic nephropathy from retinal fundus images. Methods: In this population-based study, we developed a retinal image-based AI-deep learning system, DeepDKD, pretrained using 734 084 retinal fundus images. First, for DKD detection, we used 486 312 retinal images from 121 578 participants in the Shanghai Integrated Diabetes Prevention and Care System for development and internal validation, and ten multi-ethnic datasets from China, Singapore, Malaysia, Australia, and the UK (65 406 participants) for external validation. Second, to differentiate isolated diabetic nephropathy from NDKD, we used 1068 retinal images from 267 participants for development and internal validation, and three multi-ethnic datasets from China, Malaysia, and the UK (244 participants) for external validation. Finally, we conducted two proof-of-concept studies: a prospective real-world study with 3 months' follow-up to evaluate the effectiveness of DeepDKD in screening DKD; and a longitudinal analysis of the effectiveness of DeepDKD in differentiating isolated diabetic nephropathy from NDKD on renal function changes with 4·6 years' follow-up. Findings: For detecting DKD, DeepDKD achieved an area under the receiver operating characteristic curve (AUC) of 0·842 (95% CI 0·838–0·846) on the internal validation dataset and AUCs of 0·791–0·826 across external validation datasets. For differentiating isolated diabetic nephropathy from NDKD, DeepDKD achieved an AUC of 0·906 (0·825–0·966) on the internal validation dataset and AUCs of 0·733–0·844 across external validation datasets. In the prospective study, compared with the metadata model, DeepDKD could detect DKD with higher sensitivity (89·8% vs 66·3%, p<0·0001). In the longitudinal study, participants with isolated diabetic nephropathy and participants with NDKD identified by DeepDKD had a significant difference in renal function outcomes (proportion of estimated glomerular filtration rate decline: 27·45% vs 52·56%, p=0·0010). Interpretation: Among diverse multi-ethnic populations with diabetes, a retinal image-based AI-deep learning system showed its potential for detecting DKD and differentiating isolated diabetic nephropathy from NDKD in clinical practice. Funding: National Key R & D Program of China, National Natural Science Foundation of China, Beijing Natural Science Foundation, Shanghai Municipal Key Clinical Specialty, Shanghai Research Centre for Endocrine and Metabolic Diseases, Innovative research team of high-level local universities in Shanghai, Noncommunicable Chronic Diseases-National Science and Technology Major Project, Clinical Special Program of Shanghai Municipal Health Commission, and the three-year action plan to strengthen the construction of public health system in Shanghai.http://www.sciencedirect.com/science/article/pii/S2589750025000408 |
| spellingShingle | Ziyao Meng, MEng Zhouyu Guan, MD Shujie Yu, MBBS Yilan Wu, BSc Yaoning Zhao, BSc Jie Shen, PhD Cynthia Ciwei Lim, MMed Tingli Chen, MD Dawei Yang, PhD An Ran Ran, PhD Feng He, MSc Haslina Hamzah, BSc Sarkaaj Singh, MSc Anis Syazwani Abd Raof, MSc Jian Wen Samuel Lee-Boey, MBBS ProfMBBS Soo-Kun Lim, MBBS ProfMD Xufang Sun, MBBS Shuwang Ge, MD ProfMD Gang Xu, MD Prof Hua Su, MD Yang Cheng, MD Feng Lu, PhD ProfPhD Xiaofei Liao, PhD ProfPhD Hai Jin, PhD Chenxin Deng, MMed Lei Ruan, MD ProfMD Cuntai Zhang, MD Chan Wu, MD ProfMD Rongping Dai, MD Yixiao Jin, MSc Wenxiao Wang, PhD Tingyao Li, BSc Ruhan Liu, PhD Jiajia Li, PhD Jia Shu, BEng Yuwei Lu, MBBS Xiangning Wang, MD Qiang Wu, MD Yiming Qin, BEng Jin Tang, MD Xiaohua Sheng, MD Qiong Jiao, MD ProfPhD Xiaokang Yang, MD ProfPhD Minyi Guo, MD Gareth J McKay, PhD ProfPhD Ruth E Hogg, PhD Gerald Liew, MBBS Evelyn Yi Lyn Chee, PhD ProfPhD Wynne Hsu, PhD ProfPhD Mong Li Lee, PhD Simon Szeto, MBChB ProfMD Andrea O Y Luk, MBChB ProfMD Juliana C N Chan, MBChB Carol Y Cheung, PhD Gavin Siew Wei Tan, FRCSEd Yih-Chung Tham, PhD ProfMD PhD Ching-Yu Cheng, PhD Charumathi Sabanayagam, MD PhD ProfPhD Lee-Ling Lim, MD PhD ProfMD PhD Weiping Jia, MD PhD ProfMD PhD Huating Li, MD PhD Bin Sheng, Prof Tien Yin Wong, Prof Non-invasive biopsy diagnosis of diabetic kidney disease via deep learning applied to retinal images: a population-based study The Lancet: Digital Health |
| title | Non-invasive biopsy diagnosis of diabetic kidney disease via deep learning applied to retinal images: a population-based study |
| title_full | Non-invasive biopsy diagnosis of diabetic kidney disease via deep learning applied to retinal images: a population-based study |
| title_fullStr | Non-invasive biopsy diagnosis of diabetic kidney disease via deep learning applied to retinal images: a population-based study |
| title_full_unstemmed | Non-invasive biopsy diagnosis of diabetic kidney disease via deep learning applied to retinal images: a population-based study |
| title_short | Non-invasive biopsy diagnosis of diabetic kidney disease via deep learning applied to retinal images: a population-based study |
| title_sort | non invasive biopsy diagnosis of diabetic kidney disease via deep learning applied to retinal images a population based study |
| url | http://www.sciencedirect.com/science/article/pii/S2589750025000408 |
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