High Ocular Disease Burden and Increased Referral Needs in Patients with Chronic Kidney Disease: A Step Toward Personalized Care.

Abstract

Background/Objectives: To evaluate the prevalence of eye diseases in patients with confirmed chronic kidney disease (CKD) and their referral patterns to ophthalmologists, with the aim of informing personalized screening and referral strategies. Methods: This study involved 528 CKD patients from a tertiary hospital's outpatient renal clinics in Singapore, with CKD defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m². Retinal photographs from each dilated eye were graded for the presence of diabetic retinopathy (DR) and other eye diseases by professional graders. Patients with significant eye conditions were referred to ophthalmologists based on severity and urgency, categorized as urgent (same day or within 24 h), semi-urgent (within 1-2 weeks), fast-track (within 1-3 months), or annual referrals. Results: More than half of the CKD patients (53.7%) had some form of eye disease; 20% were diagnosed with DR, and 29% required fast-track referrals. Of the 251 patients with diabetes, 67% adhered to annual follow-ups; however, despite this regular monitoring, over half required fast-track referrals for severe eye conditions. Among the 167 non-diabetic CKD patients, nearly a third (31%) were on follow-up, with 7.8% requiring fast-track referrals. Notably, 11% of those not on follow-up also needed fast-track referrals. Seven non-diabetic and ten diabetic patients required urgent referral due to critical conditions such as pseudo-holes, impending occlusions, and disc swelling. Conclusions: These findings underscore the high prevalence and severe nature of eye diseases in CKD patients, even those who are under regular annual follow-up. Integrating systematic eye screening into CKD care supports personalized medicine by enabling early detection and tailored interventions, ultimately improving both visual and overall patient outcomes.