CKD singled out for risk of eye diseases in Asians

Chronic kidney disease (CKD) contributes to an increased risk of visual impairment and eye diseases in Asian adults, according to new research.

In a multiethnic cohort of adults who participated in the Singapore Epidemiology of Eye Diseases study, those with CKD had a higher incidence of visual impairment (14.3 percent vs 3.3 percent; p<0.001), any ocular disease (66.1 percent vs 45 percent; p<0.001), age-related macular degeneration (AMD) (8 percent vs 5.4 percent; p<0.001), and cataracts (65.1 percent vs 40.8 percent; p<0.001) compared with those who had no CKD. [J Glob Health 2025;15:04316]

Notably, the incidence of VI increased with CKD severity (G1-G2: 3.3 percent; G3a: 13.5 percent; G3b-G5: 16.3 percent; p<0.001). When looking at ethnicity, VI occurred more frequently in the CKD vs no-CKD group among Chinese (16 percent vs 7.2 percent) and Malay (15.9 percent vs 4.2 percent) participants.

In multivariable logistic regression models, CKD was significantly associated with greater odds of visual impairment (odds ratio [OR], 1.47, 95 percent confidence interval [CI], 1.03–2.10) and moderate/worse diabetic retinopathy (OR, 2.62, 95 percent CI, 1.35–5.10).

Across ethnic groups, CKD showed a pronounced association with any eye disease (OR, 3.69, 95 percent CI, 1.49–9.14; p<0.001), moderate/worse diabetic retinopathy (OR, 7.74, 95 percent CI, 1.68–35.69; p<0.001), and cataract (OR, 3.04, 95 percent CI, 1.35–6.84; p<0.001) among Chinese participants. Among Indians, CKD was associated with only moderate/worse diabetic retinopathy (OR, 7.19, 95 percent CI, 2.66–19.43; p<0.001). Among Malays, CKD showed an inverse association with glaucoma (OR, 0.09, 95 percent CI, 0.01–0.71; p<0.001).

“Given the increasing prevalence of CKD worldwide, these findings highlight the importance of regular eye examinations for individuals with CKD to reduce the risk of visual impairment and age-related eye diseases,” the authors said.

The authors noted that the discrepancy observed in the results of the ethnicity-specific analyses may be attributed to ethnic differences in genetic susceptibility, or the presence of other modifying risk factors such as BP, BMI, or smoking that influence the manifestation of eye complications in CKD.

“Glaucoma showed a protective association with CKD in Malays, a finding that is not yet well understood. Studies suggest that lower intraocular pressure in CKD patients, due to fluid imbalances and other systemic factors, may play a role in glaucoma risk,” they added.

The analyses included 6,486 Singaporean adults aged 40–80 years (mean age 57.29 years, 51.5 percent female, 39.4 percent Chinese, 32.7 percent Indian, 28 percent Malay) who were free of visual impairment and eye diseases at baseline. Of these, 564 (8.7 percent) had CKD (ie, eGFR of <60 ml/min/1.73 m²). Visual impairment was defined as best-corrected visual acuity <20/40 in the better eye.

Participants with vs without CKD were older, more likely to be male, of Malay ethnicity, alcohol drinkers and had lower educational attainment.

The authors acknowledged several study limitations, including the use of a single measurement of serum creatinine and eGFR to evaluate CKD and the small number of incident events for individual eye diseases.