Topical carbonic anhydrase inhibitor eye drops risky among glaucoma patients with CKD
Globally, both the prevalence of chronic kidney disease (CKD) and glaucoma are rising rapidly. Glaucoma is a disease characterized by progressive deterioration of the optic nerve and retinal nerve fiber layer (RNFL) defect with corresponding visual field changes.1 Besides elevated intraocular pressure (IOP) as one of the risk factors, aspects such oxidative stress, hypoxia or microvascular circulation injury, can play a role in glaucoma pathogenesis as well.
Topical carbonic anhydrase inhibitor eye drops risky among glaucoma patients with CKD suggests a new study published in the American Journal of Ophthalmology
A study was done to investigate the risks of metabolic acidosis and renal outcomes after topical carbonic anhydrase inhibitor (CAI) use in patients with both primary open-angle glaucoma (POAG) and advanced chronic kidney disease (CKD).
This study was conducted with population data from Taiwan's National Health Insurance (NHI) Research Database between January 2000 and June 2009. Patients with advanced CKD who were diagnosed with glaucoma (ICD-9 code 365) and had been receiving eye drops for glaucoma (including carbonic anhydrase inhibitors selected by NHI drug code) were enrolled. Using Kaplan-Meier methods, we compared the cumulative incidence of mortality, long term dialysis and the cumulative incidence of metabolic acidosis over time between CAI users and CAI non-users with the Kaplan-Meier method. Primary outcomes comprise mortality, renal outcome (progression to hemodialysis) and metabolic acidosis.
Results
In this cohort, topical CAI users had higher incidence for long term dialysis than non-users Hospital admissions due to metabolic acidosis were higher in CAI users compared with non-users
Topical CAIs may be associated with higher risks of long term dialysis and metabolic acidosis in patients with POAG and pre-dialysis advanced CKD. Therefore, topical CAIs should be used with caution in advanced CKD patients.
Reference:
Yi-Chun Wang, Xiao Chun Ling, Wen-Hsin Tsai, Jia-Sin Liu, Ko-Lin Kuo.
Risks of Topical Carbonic Anhydrase Inhibitors in Glaucoma Patients with Chronic Kidney Disease: A Nationwide Population-Based Study. American Journal of Ophthalmology. Published:May 04, 2023 DOI: https://doi.org/10.1016/j.ajo.2023.05.007
