Increased Risk of Intraocular Pressure-Lowering Treatment in End-Stage Renal Disease Patients Undergoing Hemodialysis.

PURPOSE: To evaluate the risk of receiving intraocular pressure (IOP)-lowering treatment in patients with end-stage renal diseases (ESRD) undergoing hemodialysis (HD). DESIGN: Retrospective cohort study using electronic health record data obtained from the TriNetX US Collaborative Network. PARTICIPANTS: Patients aged ≥ 20 and ≤ 85 years with a diagnosis of ESRD and HD dependence compared to a healthy control cohort. METHODS: Incidence and relative risk for needing IOP-lowering medication or surgery were calculated in the ESRD-HD and control cohorts in an unadjusted analysis. Then, propensity score matching (PSM) was performed to match the cohorts for age and sex (Model 1). Model 2 included Model 1 with additional PSM for systemic comorbidities including diabetes, hypertension, and others. Standardized mean difference (SMD) values were used to assess matching quality. Cumulative incidences and hazard ratios (HR) with 95% confidence intervals (CI) for IOP-lowering treatment were calculated for glaucoma treatment endpoints at 5 years after the index date. MAIN OUTCOME MEASURES: Risk of new IOP-lowering treatments including medication and surgery. RESULTS: The unadjusted analysis demonstrated that the ESRD-HD cohort had a higher incidence proportion of receiving IOP-lowering medication or surgery (9.57% vs. 4.38%, P <0.001). After PSM, SMD was <0.1 for all variables, indicating good matching. In Model 1, the ESRD-HD cohort demonstrated statistically significant higher incidence and increased HRs for receiving new IOP-lowering treatment including medication or surgery 5 years after the index date (1.94,1.81-2.07; HR, 95%CI). In Model 2, the ESRD-HD cohort showed significantly higher HRs for new IOP-lowering treatment including medication or surgery (1.36, 1.26-1.46), medication use (1.38,1.32-1.44; HR, 95CI), new medication use (1.36,1.27-1.46), and new surgeries (1.57,1.20-2.05), at the 5-year timepoint. More specifically particularly high HRs in Model 2 were observed for the ESRD-HD cohort needing glaucoma drainage devices (2.09,1.34-3.25) and cyclodestruction (3.72,2.10-6.59). CONCLUSIONS: The ESRD-HD cohort was at significantly higher risk of receiving IOP-lowering treatment, ranging from medications to surgery. In particular, the ESRD-HD cohort had a higher risk of undergoing glaucoma drainage device implantation or cyclodestructive procedures, surgical interventions sometimes reserved for patients with more advanced glaucoma. Therefore, ESRD-HD patients require heightened ophthalmic surveillance to achieve timely intervention.