Chronic kidney disease and glaucoma have bidirectional association: Study

Singapore: A bidirectional association has been found between chronic kidney disease (CKD) and glaucoma in a new study conducted at the National University of Singapore. This association may be due to underlying common risk factors such as diabetes and hypertension. The research article was published in EClinicalMedicine.

Glaucoma poses a significant public health concern worldwide as it damages the optic nerve and leads to irreversible blindness if left unattended. It contributes substantially to health as well as the personal and social-economic burdens. Another highly prevalent disease is chronic kidney disease (CKD), which involves a gradual loss of kidney function. CKD has been implicated in multiple ocular diseases, including glaucoma. Both diseases share several risk factors such as diabetes, hypertension, and cardiovascular disease, and have common pathogenic pathways like oxidative stress and fluid dysregulation.

Faye Yu Ci Ng, National University of Singapore, Singapore, and colleagues conducted a study to evaluate a bidirectional association between CKD and glaucoma, as previous studies had yielded conflicting results.

Investigators searched PubMed, Embase, and Cochrane Library, including full-length English articles published in peer-reviewed journals reporting on glaucoma and CKD as either exposure or outcome, among participants aged ≥18 years. They pooled overall summary estimates of odds ratios using random-effect meta-analysis and conducted subgroup meta-analyses and univariate meta-regression. They identified 14 articles comprising 3 retrospective cohort studies and 12 cross-sectional studies from 2,428 records, including 1,978,254 participants. The risk of bias was low to moderate.

Key Findings of the study,

• Participants with CKD at baseline had 18% higher pooled odds of incident glaucoma compared to participants without CKD

• The pooled association remained significant in the subgroups of longitudinal studies, participants with diabetes, East Asian studies and primary open-angle glaucoma (POAG)

• In the reverse direction, participants with glaucoma at baseline had over three-fold higher odds of incident CKD compared to participants without glaucoma after 10-15 years of follow-up in longitudinal studies.

• 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

The investigators concluded that the meta-analysis demonstrated a two-way relationship between glaucoma and CKD in longitudinal studies. This potential association will help physicians in the comprehensive care of their patients and will inspire the prevention and management of these diseases, reducing their burden on public health and eliminating their debilitating impact on quality of life.

Future studies to elucidate underlying mechanisms and account for a differential association by ethnicity are needed, the authors wrote.

Reference:

Ng FYC, Song HJJMD, Tan BKJ, Teo CB, Wong ETY, Boey PY, Cheng CY. Bidirectional association between glaucoma and chronic kidney disease: A systematic review and meta-analysis. EClinicalMedicine. 2022 Jun 8;49:101498. doi: 10.1016/j.eclinm.2022.101498. PMID: 35747173; PMCID: PMC9189872.