Increased Burden of Vision Impairment and Eye Diseases in Patients with Chronic Kidney Disease

Abstract

Purpose: Previous studies have linked chronic kidney disease (CKD) with diabetic retinopathy (DR) and age-related macular degeneration (AMD). However, whether patients with CKD have a higher prevalence of vision impairment (VI) and other eye diseases is unknown.

Methods: We examined the prevalence of VI and major ocular diseases in persons with CKD among a multi-ethnic population-based study of 10,033 adults, aged 40-80 years who participated in the Singapore Epidemiology of Eye Diseases (SEED) Study. Of these, 1,217 (12.7%) had CKD, defined as serum creatinine-based estimated glomerular filtration rate (eGFR_cr) <60 ml/min/1.73m². VI was defined as best-corrected visual acuity worse than 20/40 in the better eye. The presence of ocular diseases, namely cataract, any-retinopathy, DR (among those with diabetes), glaucoma and AMD was assessed using a standardized ocular examination, retinal photography and visual field assessments. The associations of CKD with each of these ocular conditions were examined using logistic regression models adjusted for potential confounding factors including age, sex, race, smoking, alcohol intake, education status, body mass index, systolic blood pressure, diabetes mellitus, cholesterol levels and cardiovascular disease.

Results: The prevalence of VI and ocular disease were significantly higher in participants with CKD (46.1% and 84.8%, respectively) than in those without CKD (15.7% and 54.3%, respectively, both p<0.001). In terms of specific eye diseases, participants with CKD were more likely to have cataract (74.8% vs. 35.0%), any-retinopathy (23.9% vs 10.5%), DR (46.3% vs. 31.8%), AMD (10.8% vs. 6.2%) and glaucoma (5.8% vs. 3.3%) than those without (all p<0.001). The multivariable adjusted odds ratios (95% confidence interval) were 1.33 (1.13-1.56) for VI, 1.26 (1.01-1.58) for any major eye disease, 1.23 (1.00-1.51) for cataract, 1.79 (1.47-2.18) for any-retinopathy, 1.98 (1.51-2.60) for DR (additionally adjusting for diabetes duration and glycosylated hemoglobin levels), 0.92 (0.73-1.17) for AMD and 0.83 (0.61-1.12) for glaucoma.

Conclusions: There is a high burden of VI and major eye diseases in persons with CKD, with nearly half of them suffering from low vision. Screening and early ophthalmological referral may be useful to reduce ocular morbidity in these patients.