Risk of corneal ulcer in patients with end-stage renal disease: a retrospective large-scale cohort study

Background/Aims

To investigate the risk of corneal ulcer in patients with end-stage renal disease (ESRD).

Methods

This retrospective, nationwide, matched cohort study included 92 967 patients with ESRD recruited between 2000 and 2009 from the Taiwan National Health Insurance Research Database. The same number of age-matched and sex-matched patients without ESRD were selected from the Taiwan Longitudinal Health Insurance Database, 2000 as the control group. Data for each patient were collected from the index date until December 2011. Corneal ulcer incidence rate and risk were compared between the groups. A Cox proportional hazards regression was used to calculate the HR for a corneal ulcer after adjustment for potential confounders. The cumulative corneal ulcer incidence rate was calculated using Kaplan-Meier analysis.

Results

In total, 660 patients with ESRD and 591 controls showed a corneal ulcer during follow-up; thus, the corneal ulcer incidence rate in patients with ESRD was 1.54 times (95% CI 1.38–1.72) that in the control patients. After adjustment for potential confounders, including diabetes mellitus and HIV disease, patients with ESRD were 1.17 times (95% CI 1.03 to 1.33) more likely to develop a corneal ulcer in the cohort for the total sample. Among patients with diabetes mellitus, the corneal ulcer incidence rate was significantly higher in the ESRD group, and diabetes mellitus significantly increased corneal ulcer risk even after adjustment for other confounders in the cohort.

Conclusion

ESRD increases the risk of a corneal ulcer, particularly in patients with ESRD with diabetes mellitus. Regular ocular examinations are suggested for patients with ESRD.

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