Increased Burden of Vision Impairment and Eye Diseases in Persons with Chronic Kidney Disease — A Population-Based Study

• Persons with CKD were 3 times more likely to suffer from visual impairment than persons without CKD.
• CKD was associated with visual impairment, any ocular disease, cataract and retinopathy independent of potential risk factors.
• In persons with diabetes, odds of visual impairment increased with increasing severity of CKD.
• Our results suggest that screening for ocular disease and visual impairment is important in patients with CKD.This study reports the prevalence of visual impairment in persons with chronic kidney disease (CKD) and the associations of CKD with visual impairment and major ocular diseases, diagnosed based on comprehensive ophthalmological examination. There is a high burden of major eye diseases in persons with CKD, with nearly one in two suffering from visual impairment. Cataract and retinopathy, both independently associated with CKD, are potentially reversible causes of VI, especially if treated early. The evidence suggests a need for early eye screening in these high-risk individuals.

BackgroundChronic kidney disease (CKD) has been shown to be associated with diabetic retinopathy (DR) and age-related macular degeneration (AMD), leading causes of blindness in elderly adults in previous studies. However, the association of CKD with visual impairment (VI) is not clear. We aimed to examine the association of CKD with VI and other age-related ocular diseases in a population-based sample of Asian adults.MethodsWe analyzed data from 10,033 adults aged 40–80 years who participated in the Singapore Epidemiology of Eye Diseases (SEED, 2004–11) Study. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 from serum creatinine. VI was defined as best-corrected visual acuity < 20/40 in the better eye. Cataract, retinopathy, DR, glaucoma and AMD were assessed using standardized ocular examination, retinal photography and visual field assessments. The associations of CKD with VI and ocular conditions were examined using logistic regression models adjusted for age, sex, race, smoking, alcohol intake, education status, body mass index, systolic blood pressure, diabetes mellitus, cholesterol levels and cardiovascular disease.FindingsThe prevalence of VI and ocular disease were significantly higher in participants with CKD (36.1% and 84.7%) than in those without (12.9% and 54.3%, both p < 0.001). In multivariable models, CKD was significantly associated with VI (odds ratio [95% confidence interval] = 1.34 [1.14–1.58]), any ocular disease (1.28 [1.03–1.61]), cataract (1.24 [1.01–1.52]), any retinopathy (1.77 [1.45–2.15]), and DR (1.94 [1.47–2.54]).InterpretationThe burden of VI and eye diseases is high among persons with CKD. Our findings suggest that it may be useful to screen for ocular disease and VI in persons with CKD.