Chronic Kidney Disease and Intraocular Pressure: The Singapore Malay Eye Study

Abstract

To examine the relationship of chronic kidney disease (CKD) with intraocular pressure (IOP) and glaucoma in Malay adults in Singapore. Population-based, cross-sectional study. We included 3280 (78.8% response rate) Malay adults aged 40 to 79 years living in Singapore. Participants underwent a standardized interview, ocular examination, imaging, and laboratory investigations. Goldmann applanation tonometry was used to measure IOP. Glaucoma was diagnosed using the International Society of Geographic and Epidemiological Ophthalmology classification. Non-fasting serum glucose, glycosylated hemoglobin, and creatinine were obtained from all participants. Estimated glomerular filtration rate (eGFR) and microalbuminuria were also determined. We defined CKD as eGFR < 60 ml/min/1.73 m(2) or presence of micro/macroalbuminuria, defined as urinary albumin-to-creatinine ratio > or =17 mg/g for men and > or =25 mg/g for women. We assessed CKD, IOP, and glaucoma. The overall prevalence of CKD was 27.92% and glaucoma 4.5%. The mean (standard deviation [SD]) IOP was 15.41 (3.7) mmHg. After adjustments for age and gender, IOP was significantly higher in participants with CKD compared with those without CKD (15.8 vs 15.3 mmHg; P<0.0001). The IOP was also higher with lower levels of eGFR (P<0.001). These associations remained significant in separate stratified analyses of persons with and without diabetes, glaucoma, or both. In multiple linear regression models, persons with CKD had on average IOP that was 0.305 mmHg higher than that of persons without CKD. No association between CKD and glaucoma (age and gender adjusted odds ratio [OR], 0.82; 95% confidence interval [CI], 0.56-1.20; and multivariate adjusted OR, 0.87; 95% CI, 0.58-1.29) was found. Our population-based study in Malay adults showed that CKD is associated with higher IOP, independent of age, diabetes, and glaucoma status.