Abstract
Purpose :
Glaucoma and chronic kidney disease (CKD) are both prevalent and debilitating conditions, with pathogenic pathways such as oxidative stress and fluid dysregulation common to both diseases. However, previous studies have yielded conflicting results regarding the association between them. We aim to determine if there is a bidirectional relationship between glaucoma and CKD, thus providing a comprehensive and evidence-based summary of their association.
Methods :
We searched PubMed, Embase and Cochrane Library from inception until 15 June 2021. We included observational studies, published as full-length English articles in peer-reviewed journals, reporting on glaucoma and CKD as either exposure or outcome. We pooled odds ratios using random-effect meta-analysis and conducted subgroup meta-analyses and univariate meta regression. We assessed risk of bias using the Newcastle-Ottawa Scale (NOS) and quality of evidence using the GRADE framework. Our article is PROSPERO-registered and adherent to both PRISMA and MOOSE guidelines.
Results :
We identified 3 retrospective cohort studies and 12 cross-sectional studies from 2,428 records and included 1,978,254 participants. Risk of bias was low to moderate. Participants with CKD at baseline had higher pooled odds of glaucoma (odds ratio[OR]=1.18, 95% confidence interval[CI]=1.04-1.33, I2=66%, N=12) compared to participants without CKD. The association remained significant in the subgroups of longitudinal studies, diabetic participants, East Asian studies and primary open-angle glaucoma. In the reverse direction, participants with glaucoma at baseline had over two-fold higher odds of incident CKD compared to participants without glaucoma after 10-15 years of follow-up in longitudinal studies (OR=2.44, 95% CI=1.79-3.33, I2=74%, N=2). All studies adjusted for age and sex, while most studies adjusted for comorbidities such as diabetes and hypertension. Meta-regression identified ethnicity (East Asians vs Non-East Asians) as a significant effect moderator. Associations were robust to trim-and-fill adjustment for publication bias, single-study influence and cumulative meta-analyses.
Conclusions :
Our meta-analysis suggests a bidirectional association between glaucoma and CKD, particularly among East Asians. Further studies are required to elucidate the underlying mechanisms and account for the differential association by ethnicity.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.