Letters
Ophthalmology Urology Social determinants of health
Volume 216 - Issue 11

Taking a broader view of the health care needs of people with chronic kidney disease

Authors:  Heather G Mack, Deborah J Colville and Judith A Savige

Med J Aust 2022; 216 (11): 596-596. || doi: 10.5694/mja2.51562
Published online: 20 June 2022
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To the Editor: We thank Polkinghorne and Kerr1 for their editorial on the health care needs of people with chronic kidney disease (CKD). We write to highlight the burden of visual loss suffered by people with CKD and its effects on quality of life and mortality.

The prevalence of eye diseases associated with visual impairment (combined World Health Organization definitions of blindness and low vision) in people with CKD is about 36%, rising to about 60% in people with end‐stage renal disease.2 The commonest causes of visual impairment are diabetic retinopathy (prevalence in patients with CKD, 19–46%), cataract (prevalence, 33–75%) and age‐related macular degeneration (prevalence, 8–36%).2 Increased incidence of retinal vein occlusions and hypertensive retinopathy are also associated with CKD.

Patients receiving haemodialysis have increased risk of additional ocular complications. A recent study of 121 patients found at least one ocular finding in over 89% cases, including conjunctival (32%) and corneal (32%) calcification, and optic atrophy (19%).3 Ectopic calcification has been a common cause of irritated eyes in patients receiving dialysis, but this may be decreasing with modern dialysis methods. Increased risk of optic atrophy may be related to chronic anaemia and an increased risk of non‐arteritic anterior ischaemic optic neuropathy. Uraemic optic neuropathy is now an uncommon event.

People with CKD are recognised to have an increased risk of dying from heart disease (up to 20 times that of age and gender matched people for people on haemodialysis).4,5 Vision impairment may incrementally contribute to increased mortality; a recent meta‐analysis demonstrated an all‐cause mortality hazard ratio of 1.43 (95% CI, 1.22–1.68) for visual acuity worse than 6/18.6

Vision‐related quality of life is potentially reduced in people with CKD, affecting their ability to complete activities of daily living and their social, emotional and economic wellbeing. Vision loss is associated with increased risk of falls and increased mental health burden, typically anxiety and depression, and may limit the ability to live independently, including self‐medicating with insulin and performing home dialysis. Multiple studies show people rate losing vision as worse than losing hearing, memory, speech or a limb.7

We agree that supportive care clinics for people electing to not receive kidney replacement therapy are important, and suggest that these clinics include regular eye care services.

 

Authors

  • Heather G Mack1,2
  • Deborah J Colville1
  • Judith A Savige1
  • 1. University of Melbourne, Melbourne, VIC
  • 2. Melbourne Health, Melbourne, VIC

Correspondence: hmack@eyesurgery.com.au

Competing interests

Heather Mack is on the Novartis Advisory Board for voretigene neparvovec‐rzyl in Australia.

References

Linked content

  • MJA Editorial: Taking a broader view of the health care needs of people with chronic kidney disease

View this article on Wiley Online Library