Is Kidney Function Associated with Age-Related Macular Degeneration?: Findings from the Asian Eye Epidemiology Consortium

Can Can Xue; Ralene Sim; Miao Li Chee; Marco Yu; Ya Xing Wang; Tyler Hyungtaek Rim; Park Kyu Hyung; Kang Se Woong; Su Jeong Song; Vinay Nangia; Songhomitra Panda-Jonas; Ning Li Wang; Jie Hao; Qing Zhang; Kai Cao; Mariko Sasaki; Sei Harada; Takebayashi Toru; Kawasaki Ryo; Rajiv Raman; Janani Surya; Rehana Khan; Mukharram Bikbov; Ian Y Wong; Chui Ming Gemmy Cheung; Jost B Jonas; Ching-Yu Cheng; Yih-Chung Tham

doi:10.1016/j.ophtha.2023.12.030

Is Kidney Function Associated with Age-Related Macular Degeneration?: Findings from the Asian Eye Epidemiology Consortium

Ophthalmology. 2023 Dec 29:S0161-6420(23)00937-5. doi: 10.1016/j.ophtha.2023.12.030. Online ahead of print.

Authors

Can Can Xue¹, Ralene Sim¹, Miao Li Chee¹, Marco Yu¹, Ya Xing Wang², Tyler Hyungtaek Rim¹, Park Kyu Hyung³, Kang Se Woong⁴, Su Jeong Song⁵, Vinay Nangia⁶, Songhomitra Panda-Jonas⁷, Ning Li Wang⁸, Jie Hao⁸, Qing Zhang⁸, Kai Cao⁸, Mariko Sasaki⁹, Sei Harada¹⁰, Takebayashi Toru¹⁰, Kawasaki Ryo¹¹, Rajiv Raman¹², Janani Surya¹², Rehana Khan¹², Mukharram Bikbov¹³, Ian Y Wong¹⁴, Chui Ming Gemmy Cheung¹⁵, Jost B Jonas¹⁶, Ching-Yu Cheng¹⁷, Yih-Chung Tham¹⁸

Affiliations

¹ Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore.
² Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
³ Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
⁴ Department of Ophthalmology of Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
⁵ Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
⁶ Suraj Eye Institute, Nagpur, India.
⁷ Private practice of Prof. Jost B. Jonas and Dr Songhomitra Panda-Jonas, Heidelberg, Germany.
⁸ Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
⁹ Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
¹⁰ Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan.
¹¹ Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
¹² Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India.
¹³ Ufa Eye Research Institute, Ufa, Bashkortostan, Russian Federation.
¹⁴ Department of Ophthalmology, The Hong Kong Sanatorium & Hospital, Hong Kong SAR, China.
¹⁵ Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore.
¹⁶ Department of Ophthalmology, Medical Faculty Mannheim Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland.
¹⁷ Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore; Centre for Innovation and Precision Eye Health & Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore.
¹⁸ Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore; Centre for Innovation and Precision Eye Health & Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore. Electronic address: thamyc@nus.edu.sg.

PMID: 38160880
DOI: 10.1016/j.ophtha.2023.12.030

Abstract

Purpose: Chronic kidney disease (CKD) may elevate susceptibility to age-related macular degeneration (AMD) because of shared risk factors, pathogenic mechanisms, and genetic polymorphisms. Given the inconclusive findings in prior studies, we investigated this association using extensive datasets in the Asian Eye Epidemiology Consortium.

Design: Cross-sectional study.

Participants: Fifty-one thousand two hundred fifty-three participants from 10 distinct population-based Asian studies.

Methods: Age-related macular degeneration was defined using the Wisconsin Age-Related Maculopathy Grading System, the International Age-Related Maculopathy Epidemiological Study Group Classification, or the Beckman Clinical Classification. Chronic kidney disease was defined as estimated glomerular filtration rate (eGFR) of less than 60 ml/min per 1.73 m². A pooled analysis using individual-level participant data was performed to examine the associations between CKD and eGFR with AMD (early and late), adjusting for age, sex, hypertension, diabetes, body mass index, smoking status, total cholesterol, and study groups.

Main outcome measures: Odds ratio (OR) of early and late AMD.

Results: Among 51 253 participants (mean age, 54.1 ± 14.5 years), 5079 had CKD (9.9%). The prevalence of early AMD was 9.0%, and that of late AMD was 0.71%. After adjusting for confounders, individuals with CKD were associated with higher odds of late AMD (OR, 1.46; 95% confidence interval [CI], 1.11-1.93; P = 0.008). Similarly, poorer kidney function (per 10-unit eGFR decrease) was associated with late AMD (OR, 1.12; 95% CI, 1.05-1.19; P = 0.001). Nevertheless, CKD and eGFR were not associated significantly with early AMD (all P ≥ 0.149).

Conclusions: Pooled analysis from 10 distinct Asian population-based studies revealed that CKD and compromised kidney function are associated significantly with late AMD. This finding further underscores the importance of ocular examinations in patients with CKD.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Age-related macular degeneration; Chronic kidney disease; Estimated glomerular filtration rate.