Association Between Starting Hemodialysis for End-Stage Renal Disease and Incident Cataract Surgery: A 12-Year Nationwide Cohort Study

Abstract

PURPOSE: To evaluate incident cataract surgery in subjects who started hemodialysis for end-stage renal disease.

METHODS: A nationwide propensity score-matched cohort study was performed by using a 12-year longitudinal national health insurance database of 1,025,340 subjects. The hemodialysis cohort was composed of patients who started hemodialysis between January 2003 and December 2007 (n = 291). The control cohort was composed of randomly selected patients (5 per patient in the hemodialysis cohort; n = 1467) who were matched to the hemodialysis cohort according to a propensity score based on year of hemodialysis initiation, age, sex, residential area, household income, and frequency of medical attention. Each selected patient was followed up until 2013. Cox proportional hazard regression analysis was used to calculate the overall hazard of hemodialysis initiation in regard to incident cataract surgery after adjusting for the above factors, hypertension, and diabetes mellitus.

RESULTS: Starting hemodialysis was associated with increased incident cataract surgery (hazard ratio [HR] = 1.79; 95% confidence interval [CI], 1.34-2.41). Diabetes mellitus (HR = 1.68; 95% CI, 1.22-2.32) also increased the incidence of cataract surgery. With respect to age, the effect size of hemodialysis for incident cataract surgery was greater among younger adults (aged <60 years; HR = 5.32; 95% CI, 3.06-9.26) than among older adults (aged ≥60 years; HR = 1.17; 95% CI, 0.79-1.72).

CONCLUSIONS: Patients who began hemodialysis for end-stage renal disease were more likely to undergo cataract surgery than control subjects, and this risk was more pronounced in younger patients.