Medical Education Department, Cathay General Hospital, Taipei, Taiwan.
Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.
Am J Nephrol. 2018;48(4):278-291. doi: 10.1159/000493924. Epub 2018 Oct 18.
Age-related macular degeneration (AMD) is an important cause of blindness in aged people. Chronic kidney disease (CKD) was reported to be associated with a higher risk of AMD. However, supporting evidence was inconsistent between studies. This work intends to examine whether a positive association exists between CKD and AMD by systematic review and meta-analysis.
A systematic search of electronic databases (Medline, PubMed, Cochrane and EMBASE) and reference lists on June 2017. The key inclusion criteria were controlled trials that investigated the relationship between AMD and CKD. The outcome measures included risk ratios and/or occurrence rates of AMD in CKD vs. non-CKD population. Data were pooled according to the type of AMD by random effect model.
Twelve observational studies (3 cohorts, 2 case controls, and 7 cross-sectionals) with a total 335,601 participants were included. Eleven studies reported risk ratios and 9 reported occurrence rates. Pooled prevalence for early, advanced, and any AMD were all higher in the CKD population than in the non-CKD population. The pooled multivariate adjusted OR of CKD vs. non-CKD was 1.49 (95% CI 1.11-2.02) for early, 1.55 (95% CI 1.05-2.27) for exudative, 1.58 (95% CI 1.12-2.23) for advanced, and 1.35 (95% CI 1.05-1.73) for any AMD. However, high statistical heterogeneity and methodological diversity existed. Moreover, results were inconsistent between different study designs.
The overall results support a positive association between CKD and AMD, although some limitations exist. Given the risk that AMD is increased in CKD, regular eye screenings for the CKD population is recommended for an early detection and intervention.
年龄相关性黄斑变性（AMD）是老年人失明的重要原因。据报道，慢性肾脏病（CKD）与 AMD 的风险增加有关。然而，研究之间的证据并不一致。本研究旨在通过系统评价和荟萃分析来检验 CKD 与 AMD 之间是否存在正相关关系。
系统检索了 2017 年 6 月的电子数据库（Medline、PubMed、Cochrane 和 EMBASE）和参考文献列表。主要纳入标准为研究 AMD 与 CKD 之间关系的对照试验。结局指标包括 CKD 与非 CKD 人群中 AMD 的风险比和/或发生率。根据 AMD 的类型，采用随机效应模型对数据进行汇总。
共纳入 12 项观察性研究（3 项队列研究、2 项病例对照研究和 7 项横断面研究），共 335601 名参与者。11 项研究报告了风险比，9 项研究报告了发生率。CKD 人群中早期、晚期和任何 AMD 的患病率均高于非 CKD 人群。多变量调整后 CKD 与非 CKD 的比值比（OR）分别为早期 1.49（95%CI 1.11-2.02）、渗出性 1.55（95%CI 1.05-2.27）、晚期 1.58（95%CI 1.12-2.23）和任何 AMD 1.35（95%CI 1.05-1.73）。然而，存在高度的统计学异质性和方法学多样性。此外，不同研究设计的结果不一致。
总体结果支持 CKD 与 AMD 之间存在正相关关系，但存在一些局限性。鉴于 CKD 患者 AMD 的风险增加，建议对 CKD 人群进行常规眼部筛查，以便早期发现和干预。
