Researchers find that glaucoma and chronic kidney disease have more in common than meets the eye

A team of researchers from the Yong Loo Lin School of Medicine at the National University of Singapore (NUS Medicine) found that there is a bidirectional association between chronic kidney disease (CKD) and glaucoma. This may be due to common underlying risk factors such as diabetes and hypertension.

CKD involves the gradual loss of kidney function in blood filtration, with evidence of kidney damage for more than 3 months.1 Glaucoma is a condition characterized by a buildup of pressure in the eye, resulting in damage to the optic nerve. It affects about 3% of people over the age of 40 in Singapore and its incidence increases with age.2 Poorly controlled glaucoma can eventually lead to permanent loss of vision.

As our population ages, more are at risk of developing chronic diseases such as CKD and glaucoma. The number of Singaporeans diagnosed with CKD has increased significantly, from around 4.3 new daily cases in 2011 to around 5.7 new daily cases in 2019, with no signs of slowing down. There are currently over 8,500 dialysis patients in Singapore.3

The kidney and the eye are two organs located in separate parts of the body that are not intuitively considered to be associated. They are involved in different systems and perform different functions. The team, however, found that patients with baseline CKD had an 18% higher risk of incident glaucoma. The risk of incident glaucoma increased to 42% in patients with CKD due to diabetes. This association was more prevalent in patients of East Asian descent, including Singaporeans. Conversely, patients with glaucoma have a more than 3.6 times higher risk of CKD incidence after 10 to 15 years of follow-up.

Possible explanations for the association include the two diseases sharing common risk factors, such as diabetes, hypertension, and cardiovascular disease, as well as common disease processes such as dysfunction of the renin-angiotensin system (RAS) – in which a hormonal system is unable to regulate blood pressure, water and electrolyte balance and other functions in the body, other disease processes also include oxidative stress and inflammation. Causal mechanisms may also play a role in the occurrence of both diseases, as CRF leads to fluid overload and accumulation of toxic metabolites, disrupting osmotic pressure in the eye and at the same time accelerating arteriosclerosis, which is the hardening of the walls of the eye. blood vessels, causing microvascular compromise.

Although these results are still insufficient to conclude a causal relationship between CKD and glaucoma, they draw attention to the complex interplay of factors between the disease states. They also highlight the importance of reducing risk factors such as diabetes and hypertension that are implicated in multiple health conditions.

The study4 was released in June. The team includes NUS fifth-year medical student Faye Ng, third-year medical student Harris Song, and newly minted doctors Benjamin Tan, MD, and Teo Chong Boon, MD, along with Cheng Ching-Yu, MD , PhD, MPH, from the Department of Ophthalmology, NUS Medicine and Clinical Associate Professor Boey Pui Yi, MBBS, from the Department of Glaucoma, Singapore National Eye Centre, Singapore, and Emmett Wong, MD, from the Division of Nephrology, Department of Medicine from National University Hospital, Singapore.

“We are grateful to have the opportunity to work with brilliant mentors who have brought their clinical knowledge and expertise to this research,” Ng said in a statement. “They encouraged us to think about how we can leverage our research findings to impact population health, translating science into actionable insights and insights. Our research has shown the importance of paying attention to the complex interplay between disease states such as CKD and glaucoma, and the need to advocate for preventative health to improve overall health and well-being. , countering the increase in chronic diseases.

Cheng, supervisor of the research team, applauds the team’s efforts to uncover this important discovery.

“The team worked hard to try to uncover the associations between seemingly different organs,” Cheng concluded. “Ultimately, we hope this research will add to the narrative by educating the public that they need to pay greater attention to their chronic health risks, as it is crucial that all of the physiology of the body work in tandem to ensure a good health. .”

References

1 https://www.kidney-international.org/article/S0085-2538(15)50698-4/fulltext

2 https://www.straitstimes.com/singapore/health/local-studies-find-link-between-myopia-and-glaucoma

3 https://www.straitstimes.com/opinion/forum/forum-vital-to-do-more-upstream-to-prevent-or-delay-kidney-failure

4 Faye Yu Ci Ng, Benjamin Kye Jyn Tan, Harris Jun Jie Muhammad Danial Song, Chong Boon Tan, Chong Boon Teo, Emmett Tsc Yeung Wong, Pui Yi Boey, et al. Bidirectional association between glaucoma and chronic kidney disease: a systematic review and meta-analysis. eClinicalMedicine, published June 2022; doi: 10.1016/j.eclinm.2022.101498

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