Department of Inter-Organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, Japan.
Sado General Hospital, Japan.
Intern Med. 2024 May 1;63(9):1207-1216. doi: 10.2169/internalmedicine.2176-23. Epub 2023 Sep 29.
Objective Cataract and chronic kidney disease (CKD) occur with increasing frequency with age and share common risk factors including smoking, diabetes, and hypertension. We evaluated the risk of incident cataract surgery in patients with non-dialysis-dependent CKD and dialysis-dependent CKD compared to non-CKD patients, while taking into account the competing risk of death. Methods The participants included 1,839 patients from Sado General Hospital enrolled in the Project in Sado for Total Health (PROST) between June 2008 and December 2016 (54% men; mean age, 69 years). Among these patients, 50%, 44%, and 6% had non-CKD, non-dialysis-dependent CKD, and dialysis-dependent CKD, respectively. Results During a median follow-up of 5.6 years (interquartile range, 4.7-7.1), 193 participants underwent cataract surgery [18.7 (95% confidence interval (CI), 16.2-21.5)/1,000 person-years] and 425 participants died without undergoing cataract surgery [41.0 (95% CI, 37.4-45.2)/1,000 person-years]. The cumulative incidence of cataract surgery was the highest in the dialysis-dependent CKD group, followed by the non-dialysis-dependent CKD and non-CKD groups (log-rank p=0.002). After adjusting for potential confounding factors, the dialysis-dependent CKD group [hazard ratio (HR) 2.48; 95% CI 1.43-4.31], but not the non-dialysis-dependent CKD group (HR, 1.01; 95% CI 0.74-1.38), had a higher risk of cataract surgery than the non-CKD group. However, this association was no longer significant according to a competing risk analysis (sub-hazard ratio, 1.67; 95% CI 0.93-3.03). Conclusion Dialysis-dependent CKD patients were found to have an increased risk of cataract surgery; however, the association was attenuated and no longer significant when death was considered a competing risk.
目的 白内障和慢性肾脏病（CKD）随着年龄的增长而日益普遍，且有共同的危险因素，包括吸烟、糖尿病和高血压。我们评估了与非 CKD 患者相比，非透析依赖型 CKD 和透析依赖型 CKD 患者发生白内障手术的风险，同时考虑了死亡的竞争风险。
方法 参与者包括来自佐渡综合医院的 1839 名患者，他们于 2008 年 6 月至 2016 年 12 月参加了佐渡全面健康计划（PROST）（54%为男性；平均年龄 69 岁）。这些患者中，50%、44%和 6%分别患有非 CKD、非透析依赖型 CKD 和透析依赖型 CKD。
结果 在中位随访 5.6 年（四分位间距，4.7-7.1）期间，有 193 名参与者接受了白内障手术[18.7（95%置信区间（CI），16.2-21.5）/1000 人年]，425 名参与者在未接受白内障手术的情况下死亡[41.0（95%CI，37.4-45.2）/1000 人年]。白内障手术的累积发生率在透析依赖型 CKD 组最高，其次是非透析依赖型 CKD 组和非 CKD 组（对数秩检验 p=0.002）。在调整了潜在混杂因素后，透析依赖型 CKD 组[风险比（HR）2.48；95%CI 1.43-4.31]，而非透析依赖型 CKD 组（HR，1.01；95%CI 0.74-1.38），发生白内障手术的风险高于非 CKD 组。然而，根据竞争风险分析，这种关联不再显著（亚风险比，1.67；95%CI 0.93-3.03）。
结论 透析依赖型 CKD 患者白内障手术的风险增加；然而，当考虑死亡为竞争风险时，这种关联减弱且不再显著。
