• Visual Impairment and Eye Disease in Chronic Kidney Disease

    By Lynda Seminara
    Selected By: Richard K. Parrish II, MD

    Journal Highlights

    American Journal of Ophthalmology, May 2020

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    As the worldwide prevalence of chronic kidney disease (CKD) increases, so have efforts to investigate the link between CKD and visual impairment (VI) and major eye diseases. In one of the first large studies to assess this issue in U.S. adults, Zhu et al. confirmed a signifi­cantly higher prevalence of VI and major eye diseases in participants with CKD than in those without the disor­der, as well as links between CKD and VI and major eye diseases after adjust­ments for sex, smoking status, diabetes, hypertension, and other variables.

    For this cross-sectional analysis, the researchers extracted data for noninsti­tutionalized, nationally representative U.S. civilians 40 years old and older from the National Health and Nutrition Survey (2005 to 2008). CKD was defined as estimated glomerular filtration rate <60 mL/min/1.73 m2, and VI was defined as corrected visual acuity worse than 20/40 in the better eye. Data from questionnaires or retinal photographs were used to categorize major eye diseases, including any ocular disease (defined as presence of cataract surgery, age-related macular degeneration [AMD], glaucoma, or any retinopathy) and any objectively determined ocular disease (defined as AMD, glaucoma, or any retinopathy).

    The analysis included 5,518 partici­pants (mean age, 56.9 years). Of these, 839 had CKD. VI was much more common in those with CKD (7.7% vs. 1.1% without CKD; p < .001), and the risk of major eye diseases was up to five times higher in the CKD group. After adjustment for multiple confounding variables, participants with CKD had 1.65- to 2.34-fold higher odds of VI (odds ratio [OR], 2.01), any ocular disease (OR, 1.65), any objectively de­termined ocular disease (OR, 1.52), any retinopathy (OR, 1.70), and diabetic retinopathy (OR, 2.34). The ORs for cataract surgery, AMD, and glaucoma were not significant. Stratification by diabetes status showed that CKD was linked to VI in patients with diabetes and to any ocular disease in patients without diabetes.

    The authors speculated that the relationships between CKD and VI and major eye disease observed in their study reflect common risk profiles (such as age, diabetes, hypertension, or obesity) and pathogenesis (such as atherosclerosis, oxidative stress, or inflammation). They suggested that further research on the pathogenesis of eye and renal disease could lead to development of viable treatments for both. Meanwhile, they stressed the im­portance of early ophthalmic screening of patients with CKD.

    The original article can be found here.