| dc.description.abstract | Background: Chronic Kidney Disease (CKD) is a growing public health problem worldwide with a higher prevalence documented in developing countries. CKD results in multiple body organ dysfunction thus contributing significantly to morbidity and mortality worldwide. The eye is not spared by the effects of CKD. Visual impairment (VI) and ocular complications occur frequently in persons with CKD. Despite the high prevalence of CKD in developing countries such as Uganda no study has documented the ocular findings, prevalence of visual impairment among CKD patients in our setting.
Aim: This study aimed to document the ocular findings, and the prevalence of visual impairment and its associated factors in patients diagnosed with CKD at Kiruddu National Referral Hospital in Kampala, Uganda.
Methodology: This was a cross-sectional study, where we consecutively recruited 171 participants aged 18 years and older with a diagnosis of CKD attending the renal out-patient clinic in Kiruddu National Referral Hospital from the period between August 2022 to October 2022. After obtaining consent; all participants had a detailed medical and social history taken and underwent a detailed medical and systemic examination to determine the presence of comorbidities and risk factors for CKD. A detailed ocular examination was then performed to determine the presence of VI and pattern of ocular disorders in these patients. Details of findings obtained from the history and clinical examinations were recorded in a structured questionnaire. Data was then entered using Epidata version 3.0 and analyzed using STATA version 14.0.
Results: A total of 171 patients with CKD aged 18 to 90 years, mean 48.2 years(SD=15.8) were recruited. The male to female ratio was 1:1. The majority ( 60.8%) had a normal BMI, while obesity and overweight was present in 3.5% and 27.5% respectively. Positive history of smoking and alcohol use was present in 4.8% and 29.2% respectively. Sixty three percent of these patients presented with advanced stages of CKD( stage 4 and 5) and 12.3% were on dialysis. The commonest causes of CKD were hypertension(67.8%), diabetes(28.1%) and HIV(18.2%). VI impairment was present in 48.5% and this was caused by refractive errors(50.9%), cataracts (41.2%), and retinopathies(32.2%).
Eighty percent of the 342 eyes examined had adnexal/anterior segment ocular findings. The most frequent ocular findings were conjunctival pallor (42.9%), Dry eye (41.5%), cataracts(41.2%), retinopathies(32.2% and lid edema(25.5%). The sight threatening ocular disorders included retinopathies(32.2%), maculopathies, optic disc atrophy and cupping, vitreous hemorrhage and cataracts.
Statistically significant relationship was noted between VI and worsening CKD stage(aPR-1.41 p 0.044), ages above 50 years(aPR-2.91 p 0.023), positive smoking history(aPR – 1.66 p 0.004), uncontrolled Hypertension(aPR – 1.37 p 0.020), and poor glycemic control(aPR – 1.55,p 0.021).
Conclusions/Recommendation:
VI and ocular disorders are highly prevalent in patients with advanced stages of CKD. There is need for integrated routine ocular examinations of CKD patients to prevent irreversible blindness. | en_US |
