Risk of Nonarteritic Anterior Ischemic Optic Neuropathy Following End-Stage Renal Disease

Yuh-Shin Chang; Shih-Feng Weng; Chun Chang; Jhi-Joung Wang; Shih-Bin Su; Chien-Cheng Huang; Jiu-Yao Wang; Ren-Long Jan

doi:10.1097/MD.0000000000003174

Risk of Nonarteritic Anterior Ischemic Optic Neuropathy Following End-Stage Renal Disease

Medicine (Baltimore). 2016 Mar;95(12):e3174. doi: 10.1097/MD.0000000000003174.

Authors

Yuh-Shin Chang¹, Shih-Feng Weng, Chun Chang, Jhi-Joung Wang, Shih-Bin Su, Chien-Cheng Huang, Jiu-Yao Wang, Ren-Long Jan

Affiliation

¹ From the Department of Ophthalmology (YSC), Department of Medical Research (JJW), Department of Anesthesiology (JJW), Department of Occupational Medicine, Chi Mei Medical Center (SBS), Graduate Institute of Medical Science, College of Health Science, Chang Jung Christian University (YSC), Department of Child Care and Education, Southern Taiwan University of Science and Technology (CCH), Graduate Institute of Clinical Medicine, National Cheng Kung University (JYW, RLJ), Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan (RLJ), Department of Leisure, Recreation, and Tourism Management, Tainan (SBS, CCH), Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung (SFW), and Department of Education, University of Taipei, Taipei, Taiwan (CC).

Abstract

To investigate the risk of nonarteritic anterior ischemic optic neuropathy (NAION) following end-stage renal disease (ESRD).A retrospective, nationwide, matched cohort study.ESRD patients identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 585.The study cohort included 93,804 ESRD patients registered with the Taiwan National Health Insurance Research Database between January 2000 and December 2009. An age- and sex-matched control group comprised 93,804 patients (case:control = 1:1) selected from the Taiwan Longitudinal Health Insurance Database 2000. Information for each patient was collected from the index date until December 2011. The incidence and risk of NAION were compared between the ESRD and control groups. The adjusted hazard ratio (HR) for NAION after adjustment for potential confounders was obtained by a Cox proportional hazard regression analysis. A Kaplan-Meier analysis was used to calculate the cumulative incidence rate of NAION.The incidence of NAION following ESRD.In total, 133 ESRD patients (0.14%) and 51 controls (0.05%) had NAION (P < 0.001) during the follow-up period, leading to a significantly elevated risk of NAION in the ESRD patients compared with the controls (incidence rate ratio = 3.14, 95% confidence interval [CI] = 2.11-4.67). After adjustment for potential confounders including diabetes mellitus, hypertension, hypotension, hyperlipidemia, and 2-way interaction terms between any 2 factors, ESRD patients were 3.12 times more likely to develop NAION than non-ESRD patients in the full cohort (adjusted HR = 3.12, 95% CI = 2.10-4.64). Additionally, patients with hypertension and hyperlipidemia showed higher incidence rates of NAION in the ESRD group compared with the controls: 2.31 (95% CI = 1.40-3.82) for hypertension and 2.72 (95% CI = 1.14-6.50) for hyperlipidemia.ESRD increased the risk of NAION, which is an interdisciplinary emergency. Close collaboration between nephrologists and ophthalmologists is important in NAION management following ESRD to prevent fellow eye involvement.

MeSH terms

Aged
Cohort Studies
Female
Humans
Kidney Failure, Chronic / complications*
Male
Middle Aged
Optic Neuropathy, Ischemic / epidemiology
Optic Neuropathy, Ischemic / etiology*
Retrospective Studies
Risk Factors
Taiwan