评估慢性肾脏病患者新发青光眼的风险：一项全国性队列研究。

Evaluating the risk of new-onset glaucoma in chronic kidney disease patients: a nationwide cohort study.

机构信息

Department of Ophthalmology, China Medical University Hospital, China Medical University, No. 29, Yude Rd., North Dist., Taichung, 40447, Taiwan.

School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.

出版信息

BMC Nephrol. 2024 Aug 15;25(1):263. doi: 10.1186/s12882-024-03698-5.

DOI:10.1186/s12882-024-03698-5

PMID:39143548

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11325696/

Abstract

BACKGROUND

A better understanding of the association between chronic kidney disease (CKD) and glaucoma is required to optimize clinical outcomes. Therefore, this study aimed to investigate the association of chronic kidney disease (CKD) with new diagnoses of glaucoma over time from January 2009 to December 2019.

METHOD

This retrospective propensity-matched cohort study utilizing Taiwanese electronic health records examined the incidence of newly diagnosed glaucoma in patients with and without chronic kidney disease (CKD). The exposure variable was the diagnosis of CKD, identified through diagnostic codes. The primary outcome was the incidence of new-onset glaucoma. Subgroup analyses on glaucoma risk included age, gender, comorbidities, glaucoma subtypes, and dialysis status. Statistical analyses included Kaplan-Meier analysis, Cox proportional hazards models, and Poisson regression models, with the associated hazard ratios and confidence intervals reported.

RESULTS

Seven hundred twenty-three thousand two hundred sixteen patients with CKD (42.3% female; mean [SD] age at index, 66.3 [15.6] years) and 723,216 patients without CKD (42.3% female; mean [SD] age at index, 66.3 [15.7]) were recruited. We showed a significantly increased risk of glaucoma irrespective of subtypes in CKD patients compared to those without CKD (HR: 1.29 [CI: 1.26-1.32], p < 0.001). Kaplan-Meier curves revealed a significantly increased glaucoma risk in both the dialytic subtype and non-dialytic CKD patients when compared to their non-CKD counterparts (p < 0.001). We also showed that all genders (aHR 1.17 [CI: 1.13-1.21] for females vs. aHR 1.39 [CI:1.35-1.43] for males), all ages (< = 49: aHR 1.49 [CI: 1.37-1.62]; 50-59: aHR 1.48 [CI: 1.40-1.56]; 60-69: aHR 1.30 [CI: 1.25-1.6]; 70-79: aHR 1.21 [CI: 1.17-1.26]; > 80: aHR 1.29 [CI: 1.21-1.37]); all income brackets and all urbanization status were associated with significantly increased risk of glaucoma from among the CKD cohort when compared to their respective non-CKD cohort (p < 0.001).

CONCLUSIONS

Our cohort study spanning 12 years showed an elevated glaucoma risk following a CKD diagnosis compared to a frequency-matched non-CKD cohort. Our findings have relevance for the clinical practice of at-risk CKD patients.

TRIAL REGISTRATION

Due to the retrospective nature of the study, no registration was necessary.

摘要

背景

为了优化临床结果，需要更好地了解慢性肾脏病（CKD）与青光眼之间的关联。因此，本研究旨在调查 2009 年 1 月至 2019 年 12 月期间慢性肾脏病（CKD）与新诊断的青光眼之间随时间变化的关联。

方法

本回顾性倾向评分匹配队列研究利用台湾电子健康记录，检查了 CKD 患者（42.3%为女性；指数年龄的平均值[标准差]为 66.3[15.6]岁）和无 CKD 患者（42.3%为女性；指数年龄的平均值[标准差]为 66.3[15.7]岁）中新诊断青光眼的发生率。暴露变量为通过诊断代码确定的 CKD 诊断。主要结局是新发青光眼的发生率。青光眼风险的亚组分析包括年龄、性别、合并症、青光眼亚型和透析状态。统计分析包括 Kaplan-Meier 分析、Cox 比例风险模型和泊松回归模型，报告相关的风险比和置信区间。

结果

共招募了 723216 例 CKD 患者（42.3%为女性；指数年龄的平均值[标准差]为 66.3[15.6]岁）和 723216 例无 CKD 患者（42.3%为女性；指数年龄的平均值[标准差]为 66.3[15.7]岁）。与无 CKD 患者相比，我们发现 CKD 患者无论青光眼亚型如何，青光眼的风险均显著增加（HR：1.29[CI：1.26-1.32]，p<0.001）。Kaplan-Meier 曲线显示，与非 CKD 对照组相比，透析和非透析 CKD 患者的青光眼风险均显著增加（p<0.001）。我们还发现，所有性别（女性的 aHR 为 1.17[CI：1.13-1.21]，男性的 aHR 为 1.39[CI：1.35-1.43]）、所有年龄（<=49 岁：aHR 为 1.49[CI：1.37-1.62]；50-59 岁：aHR 为 1.48[CI：1.40-1.56]；60-69 岁：aHR 为 1.30[CI：1.25-1.6]；70-79 岁：aHR 为 1.21[CI：1.17-1.26]；>80 岁：aHR 为 1.29[CI：1.21-1.37]）、所有收入阶层和所有城市化程度与 CKD 队列相比，青光眼风险显著增加，而非相应的非 CKD 队列（p<0.001）。