Increased Risk of Intraocular Pressure-Lowering Treatment in Patients with End-Stage Renal Disease Undergoing...

To evaluate the risk of receiving intraocular pressure (IOP)-lowering treatment in patients with end-stage renal diseases (ESRD) undergoing hemodialysis (HD).

Retrospective cohort study using electronic health record data obtained from the TriNetX US Collaborative Network.

Patients aged ≥ 20 and ≤ 85 years with a diagnosis of ESRD and HD dependence compared to a healthy control cohort.

Incidence and relative risk for needing IOP-lowering medication or surgery were calculated in the ESRD on HD (ESRD-HD) and control cohorts in an unadjusted analysis. Then, propensity score matching (PSM) was performed to match the cohorts for age and sex (Model 1). Model 2 included Model 1 with additional PSM for systemic comorbidities including diabetes, hypertension, and others. Standardized mean difference (SMD) values were used to assess matching quality. Cumulative incidences and hazard ratios (HR) with 95% confidence intervals (CIs) for IOP-lowering treatment were calculated for glaucoma treatment endpoints at 5 years after the index date.

Risk of new IOP-lowering treatments including medication and surgery.

The unadjusted analysis demonstrated that the ESRD-HD cohort had a higher incidence proportion of receiving IOP-lowering medication or surgery (9.57% vs. 4.38%, P < 0.001). After PSM, SMD was <0.1 for all variables, indicating good matching. In Model 1, the ESRD-HD cohort demonstrated statistically significant higher incidence and increased HRs for receiving new IOP-lowering treatment including medication or surgery 5 years after the index date (1.94, 1.81-2.07; HR, 95% CI). In Model 2, the ESRD-HD cohort showed significantly higher HRs for new IOP-lowering treatment including medication or surgery (1.36, 1.26-1.46), medication use (1.38, 1.32-1.44; HR, 95 CI), new medication use (1.36, 1.27-1.46), and new surgeries (1.57, 1.20-2.05), at the 5-year time point. More specifically particularly high HRs in Model 2 were observed for the ESRD-HD cohort needing glaucoma drainage devices (GDDs) (2.09, 1.34-3.25) and cyclodestruction (3.72, 2.10-6.59).

The ESRD-HD cohort was at significantly higher risk of receiving IOP-lowering treatment, ranging from medications to surgery. In particular, the ESRD-HD cohort had a higher risk of undergoing GDD implantation or cyclodestructive procedures, surgical interventions sometimes reserved for patients with more advanced glaucoma. Therefore, patients with ESRD-HD require heightened ophthalmic surveillance to achieve timely intervention.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.