Prevalence of Visual Impairment and Effects on Quality of Life (QoL) in a Population of Inner-City Patients with ESKD

Background: Kidney disease is often associated with eye disease. We investigated the prevalence of visual impairment and impact on QOL in an inner city population of pts with ESKD. Methods: A random convenience sample of 13 hemodialysis and 13 kidney transplant pts were surveyed face to face regarding their visual ability utilizing general vision-related questions and the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). Results: Mean age was 61.8±2.5yrs, 15 male (58%), 22 (85%) identified as Black, 59% (13) made <$40K/yr. 41% (10/24) rated their vision as fair to poor. Higher income was associated with better vision related mental health (r=0.6, p=0.005), despite no association with personal vision rating. Mean HbA1c was 6.2±0.2, range 4.7-8.8. Higher HbA1c was associated with eye discomfort (r=0.68, p<0.001), difficulty seeing at night (r=0.44, p=0.03), inability to accomplish tasks (r=-0.45, p=0.03), limitation due to optic pain or discomfort (r=-0.63, p=0.01), being more likely to stay home (r=-0.51, p=0.01) and feeling less control (r=-0.59, p=0.002). Pts who stayed home were also more likely to report no longer reading the newspaper or doing close activities (r=-0.61, p=0.002), being unable to read street signs (r=-0.59, p=0.002), find things (r=-0.77, p<0.001) or use stairs (r=-0.77, p=0.001). They also reported difficulty judging facial reactions (-0.69, p<0.001), frustration (r=0.85, p<0.001), inability to work (r=0.74, p<0.001), increased dependency (r=-0.78, p<0.001), decreased mental health (r=0.84, p<0.001) and decreased social interactions (r=0.78, p<0.001). There was no difference between dialysis and txp pts or males and females. Conclusion: In our population: 1. Almost half of pts rated their vision as fair to poor 2. Pts with higher income had better adjustment to visual limitations. 3. Higher HbA1c was associated with more symptoms, decreased social interaction, and feeling less control. 3. Limited vision patients reported stopping normal daily activities , inability to work, decreased mental health and increased dependency. 4. Visual impairment has far reaching impact on QoL in pts with ESKD and may be overlooked given other medical issues. Decreased visual function should be recognized and addressed early in the course of kidney disease, with targeted support provided for the already visually impaired.