Chronic kidney disease and its association with cataracts–A cross-sectional and longitudinal study

Introduction: We aim to explore the association between chronic kidney disease (CKD) and cataracts.

Methods: A total of 121,380 participants with adequate information collected from 29 community-based recruitment centers since 2008 were analyzed. The association between CKD and self-reported diagnosed cataracts was examined in a cross-sectional cohort and was validated in a longitudinal cohort of 25,263 participants without cataracts at baseline.

Results and discussion: Of all participants, cataracts occurred in 503/1,947 (26%) and 10,464/119,433 (9%) subjects in the CKD and non-CKD groups, respectively. Multivariate logistic regression showed that CKD was significantly associated with a higher prevalence of self-reported diagnosed cataracts. In the validation cohort, a higher incidence of cataracts was also noted in the CKD group (65/317, 21%) compared to the non-CKD group (1,964/24,252, 8%) during a mean 47-month follow-up. After adjusting for confounders, subjects with CKD had a 1.498-fold higher risk of incident cataracts than those without CKD (95% confidence interval = 1.114 to 2.013, p value = 0.007). We found that CKD was associated with a higher prevalence of cataracts as well as incident cataracts, which suggests CKD patients and their primary physicians should be aware of this disease and can provide a clue for further exploration of the possible mechanisms and treatments.

Introduction

Cataracts, or opacification of the lens, are a significant cause of blindness especially in middle to low-income countries. It is estimated that over 15.2 million people are blind and over 78.8 million people are moderate to severe vision impaired secondary to cataracts worldwide (1). Despite advances in cataract surgery, cataracts continue to be a public health and financial burden due to the extended life expectancy and growing population. In order to identify the reversible risk factors of cataracts, it is important to halt the disease's development.

Chronic kidney disease (CKD), defined as decreased kidney function or presence of kidney damage for 3 or more months, is associated with several diseases, including hypertension (2), diabetes mellitus (DM) (3), and cerebral vascular disease (4). Moreover, CKD shares common pathogenetic mechanisms with various eye diseases, such as microvascular dysfunction, epithelial dysfunction, oxidative stress an inflammation (5). Recent studies have examined the association between CKD and cataracts (6, 7), but lack evidence of large-scale cross-sectional and longitudinal cohort studies. Here, we present major evidence for the association between CKD and cataracts.

Materials and methods

Data source and study population

All participants were enrolled at 29 community-based recruitment centers in Taiwan since 2008. They were between 30 and 70 years old and had no history of malignancies when joining the cohort. Other detailed information has been described previously (8–10). In the cross-sectional cohort, a total of 121,380 participants with adequate information about age, sex, serum creatinine and history of cataracts, and possible confounders were analyzed (Figure 1). Then, a longitudinal cohort enrolled 25,263 participants without cataracts at baseline and with adequate long-term follow-up was used to validate the results of the cross-sectional analysis (Figure 1). The investigations followed the Declaration of Helsinki and participants signed a consent form. This study was approved by our institute (KMUHIRB-E(I)-20210058).

FIGURE 1

Figure 1. Study participants were classified by the presence of chronic kindey disease.

Definition of CKD

In the present study, CKD is defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m². Based on eGFR, we divided participants into CKD and non-CKD groups. Equation used to calculate eGFR (ml/min/1.73 m²) is [(140–age) × body weight / (0.814 × Serum creatinine in μmol/L)] × (0.85 if female).

Self-reported diagnosed cataracts

Firstly, participants were asked, “Have you ever been diagnosed with cataracts?” Self-reported diagnosed cataracts were defined as participants answering “Yes” to this question. For those that have a past history of cataracts, they would be asked “Which eye was diagnosed with cataracts?” and “When were you diagnosed with cataracts?” Researchers would repeat these questions to ensure consistent responses.

Variables and variables selection

All the variables in this study came from questionnaires, physical examination, and blood draws. The potential risk factors for the association between CKD and cataracts were identified through literature reviews, including age (11, 12), gender (13), body mass index (14), smoking status, alcohol status (15), education status, hypertension (including systolic and diastolic pressures) (16), diabetes mellitus (including fasting glucose), dyslipidemia (including total cholesterol and triglyceride), hemoglobin (17), albumin (18) and uric acid (19). To further identify the possible confounders, these variables were further investigated for their association with cataracts through univariate logistic regression, and then put into multivariate analysis if they were significant.

Statistical analyses

In the present study, participants were classified as CKD and non-CKD groups. Their clinical characteristics were described as percentages for qualitative variables and mean ± standard deviation for quantitative variables. The differences between groups were calculated by using Pearson χ² test or independent t-test, depending on the types of variables. To determine the association between the presence of CKD and cataracts, univariate and multivariate logistic regression analyses were used with odds ratios (ORs) and 95% confidence intervals (CIs). SPSS 20.0 (?IBM Corp, Armonk, NY, USA) and R version 3.6.2 (R Foundation for Statistical Computing, Wien, Austria) were two statistical tools we used and a p-value of <0.05 was regarded as statistically significant.

Results

Clinical characteristics of the study participants in the cross sectional cohort

The clinical characteristics for all participants, those with CKD and those without CKD are shown in Table 1. Of the 121,380 participants, 77,764 (64%) were female, and 1,947 (2%) and 119,433 (98%) were classified as CKD and non-CKD groups, respectively. The subjects with CKD were more likely to be male gender, older, had higher body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP), and a higher prevalence of smoking, drinking, past history of hypertension, past history of DM, and past history of dyslipidemia compared to the men without CKD (Table 1). In addition, self-reported diagnosed cataracts occurred in 503/1,947 (26%) and 10,464/119,433 (9%) subjects in the CKD and non-CKD groups, respectively (Table 1).

TABLE 1

Table 1. Clinical characteristics of the cross-sectional cohort (n = 121,380).

The association between CKD and prevalence of cataracts

To examine the association between CKD and self-reported diagnosed cataracts, logistic regression analyses were used. Univariate logistic regression showed that age, sex, BMI, smoking, drinking, educational status, SBP, DBP, past history of hypertension, past history of DM, past history of dyslipidemia, serum hemoglobin, albumin, fasting glucose, total cholesterol, triglyceride, and CKD were significantly associated with self-reported diagnosed cataracts (Table 2). After adjustment for confounders, age, sex, BMI, smoking, DBP, past history of hypertension, past history of DM, past history of dyslipidemia, serum albumin and CKD were still significantly related to cataracts (Table 2). Compared with those in the non-CKD group, the odds of cataracts in the CKD group were 3.627 (95% CI = 3.271–4.023, p-value = <0.001) and 1.335 (95% CI = 1.189–1.500, p-value = <0.001) in univariate and multivariate analyses, respectively. We further divided participants by age (<60 years old and ≧60 years old) and the results remained the same (Supplementary Table 1).

TABLE 2

Table 2. Odds ratios for self-reported diagnosed cataracts in univariable and multivariable binary logistic analysis in the cross-sectional cohort (n = 121,380).

The association between CKD and the development of cataracts

To further validate the association between CKD and cataracts, the risk of CKD for developing cataracts was evaluated in a longitudinal subgroup of 24,569 participants who had no history of cataracts at baseline (Table 3). In this cohort, 15,876 (65%) were female and incident cataracts occurred in 2,029 (8%) participants during a mean 47-month follow-up. The subjects with CKD were more likely to be male gender, older, had higher BMI, SBP, and DBP, and a higher prevalence of smoking, drinking, past history of hypertension, past history of DM, and past history of dyslipidemia compared to the men without CKD (Table 3). A higher incidence of cataracts was noted in the CKD group (65/317, 21%) compared to the non-CKD group (1,964/24,252, 8%). Univariate logistic regression showed that age, sex, smoking, drinking, SBP, past history of hypertension, past history of DM, past history of dyslipidemia, serum albumin, fasting glucose, total cholesterol, triglyceride, and CKD were significantly associated with incident cataracts (Table 4). In multivariate analysis, the risk of developing cataracts was still higher in participants with older age, past history of DM, past history of dyslipidemia, and CKD (Table 4). Compared with those in the non-CKD group, the odds of cataracts in the CKD group were 2.927 (95% CI = 2.220–3.860, p-value = <0.001) and 1.498 (1.114–2.013, p-value = 0.007) in univariate and multivariate analyses, respectively. We further divided participants by age (<60 years old and >60 years old) and the results for those ≧60 years old were similar to the entire cohort; however, for those <60 years old, the relationship between CKD and cataracts was not statistically significant (Supplementary Table 2).

TABLE 3

Table 3. Clinical characteristics of the longitudinal cohort (n = 24,569).

TABLE 4

Table 4. Odds ratios for self-reported diagnosed cataracts in univariable and multivariable binary logistic analysis in the longitudinal cohort (n = 24,569).

Discussion

In this study, we found that the risk of cataracts was higher in CKD patients (OR = 1.335; 95% CI, 1.189–1.500) in the cross-sectional cohort after adjusting for confounders. Furthermore, we examined 24,569 participants who had mean follow up periods of 47-months from 29 community-based recruitment centers without a history of cataracts at baseline and found that the incidence of developing cataracts (OR = 1.498; 95% CI, 1.114–2.013) is significantly higher in patients with CKD. To the best of our knowledge, this is the first large-scale cross-sectional and longitudinal study to investigate the relationship between CKD and risk of cataracts.

There were several previous cohort studies evaluating the association between CKD and cataracts but the results varied. Klein et al. (20) conducted a prospective study over a 5 years period in 1988 and found that renal function abnormalities were not significantly associated with incidence of cataracts after controlling for age and gender. Huynh et al. (21) found that there were no significant effects of CKD stage on the incidence of any type of cataract in agreement with that of Klein et al. However, they reported increased odds of incident cataract surgery in patients with moderate to severe renal dysfunction younger than 60 years of age. The authors attributed this effect to additional factors involving patients undergoing cataract surgery. Klein et al. (22) further investigated the relationship between cystatin C and the 15-year incidence of age-related cataracts in 2008. They concluded with contradictory results that increasing cystatin C levels was associated with an increased risk of age-related cataracts, especially cortical and posterior subcapsular subtypes. In recent years, Liu et al. (7) retrospectively analyzed 1-million subjects from a Taiwanese health insurance database. They found that the risk of cataract was higher in CKD group (adjusted hazard ratio 1.86) than non-CKD group and an even higher risk of cataracts in end stage renal disease group (adjusted hazard ratio 2.33), which indicated more severe renal dysfunction increased the risk of cataracts. However, the accuracy of the diagnosis of CKD and cataracts recorded by the International Classification of Disease Codes (ICD) has been questioned. The study performed by Rim et al. (23) also concluded that end stage renal disease patients who started hemodialysis were more likely to undergo cataract surgery. The results of our study were consistent with Liu et al. but constructed on more solid evidence by combining cross-sectional and longitudinal cohorts. In addition, patients diagnosed with CKD were based on eGFR in our study compared to Liu et al. which used ICDs.

Age-related cataracts comprised the vast majority of cataracts, but the risk factors were different from early-onset cataracts. Some known risk factors for early-onset cataracts included trauma, ultraviolet-B exposure, steroid use, diabetes mellitus and myotonic dystrophy, but not CKD (24–26). In our longitudinal cohort, we divided participants by age (<60 years old and ≧60 years old) and found that the relationship between CKD and cataracts was not statistically significant in those <60 years old, supporting the previous results.

In addition to CKD, we found that diabetes mellitus and dyslipidemia were associated with an increasing risk of cataracts. Our investigation was similar to the results of Liu et al. (7) in which diabetes and hyperlipidemia were independent risk factors associated with cataracts but contradictory results of alcohol use. Moreover, several previous studies have been performed which verified the association between diabetes and cataracts (27–31), and dyslipidemia and cataracts (32–34).

Proven by Liu et al. (7) the risk for cataracts increased with the severity of renal impairment. The results indicated that prevention of CKD progression and early eye screening programs might decrease the incidence of cataracts. As for diabetes, previous studies showed better glycaemic control was associated with a lower incidence of cataracts (34–36). A meta-analysis concluded that statin therapy could protect against cataract formation (37). Our study further validated the association between cataracts and CKD, diabetes mellitus and dyslipidemia which provided physicians perspectives on early screening and prevention of cataracts in these populations.

Several mechanisms were proposed to contribute to the relationship between CKD and cataracts. Urea sequestration in the lens with subsequent water accumulation and formation of osmotic cataracts was one of the possible mechanisms (38). Another possible mechanism was oxidative stress in CKD patients forming advanced glycation end products (AGEs) and leading to cataract formation (39, 40). AGEs acting on endothelial cells could lead to apoptosis, cell cycle arrest and generation of proinflammatory cytokines. These factors cause insolubility of lens proteins, accumulation of fluorescent products in the lens nucleus and the lens eventually losing its transparency.

This is the first study combining cross-sectional and longitudinal cohorts to analyze the association between CKD and risk of cataracts. Additionally, the diagnosis of CKD was based on eGFR, not by coding. Despite these strengths, the present study has several limitations. Firstly, data on cataracts were obtained from questionnaires, thus the diagnosis of cataracts lacked objective comprehensive ophthalmic examinations, and we did not have patient data for cataract subtypes and grades, nor for surgical modality and surgery-related complications; however, this substitution has been validated in other large-scale studies (41–43). Secondly, the database did not include other risk factors of cataracts, such as myopia, eye trauma, steroid use, ultraviolet light exposure and uveitis but recruited as many confounders as possible to strengthen the results. Thirdly, this study only involved Asians, so the results might not be representative of other ethnicities. Fourthly, we were unable to analyze the association between severity of CKD and cataracts because we had fewer than 100 subjects with end-stage renal disease. Fifthly, a rigorous definition of CKD should include follow-up eGFR data over 3-months and evidence of proteinuria, as opposed to a single eGFR at the time of admission. However, this substitution has been validated in other large-scale studies (44, 45). Finally, information regarding genetic testing was lacking, but most of the subjects in this study did not have congenital cataracts (46).

Conclusion

We found that CKD was associated with a higher prevalence of cataracts as well as incident cataracts, which suggests CKD patients and their primary physicians should be aware of this disease and can provide a clue for further exploration of the possible mechanisms and treatments.

Data availability statement

The data analyzed in this study is subject to the following licenses/restrictions: The data underlying this study are from the Taiwan Biobank. Due to restrictions placed on the data by the Personal Information Protection Act of Taiwan, the minimal data set cannot be made publicly available. Data may be available upon request to interested researchers. Please send data requests to S-CC (scarchenone@yahoo.com.tw), Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University.

Ethics statement

The studies involving human participants were reviewed and approved by Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-E(I)-20210058). The patients/participants provided their written informed consent to participate in this study.

Author contributions

Conceptualization, methodology, software, data curation, writing—review and editing, visualization, and project administration: J-HG. Formal analysis: J-IL and J-HG. Investigation: C-WC and Y-HL. Validation, resources, supervision, and funding acquisition: S-PH and S-CC. Writing–original draft preparation: C-YH. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported partially by the Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, from the Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan and by Kaohsiung Medical University Research Center Grant (KMU-TC111A01-1 and KMUTC111IFSP01).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2022.1029962/full#supplementary-material

References

1. GBD 2019 Blindness and Vision Impairment Collaborators Vision Vision Loss Expert Group of the Global Burden of Disease Study. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the right to sight: an analysis for the global burden of disease study. Lancet Glob Health. (2021) 9:e144–60. doi: 10.1016/S2214-109X(20)30489-7

PubMed Abstract | CrossRef Full Text | Google Scholar

2. Tedla FM, Brar A, Browne R, Brown C. Hypertension in chronic kidney disease: navigating the evidence. Int J Hypertens. (2011) 2011:132405. doi: 10.4061/2011/132405

PubMed Abstract | CrossRef Full Text | Google Scholar

3. Allison SJ. Urea inhibits insulin secretion in Ckd. Nat Rev Nephrol. (2016) 12:581. doi: 10.1038/nrneph.2016.131

PubMed Abstract | CrossRef Full Text | Google Scholar

4. Lau WL, Huisa BN, Fisher M. The cerebrovascular-chronic kidney disease connection: perspectives and mechanisms. Transl Stroke Res. (2017) 8:67–76. doi: 10.1007/s12975-016-0499-x

PubMed Abstract | CrossRef Full Text | Google Scholar

5. Wong CW, Wong TY, Cheng CY, Sabanayagam C. Kidney and eye diseases: common risk factors, etiological mechanisms, and pathways. Kidney Int. (2014) 85:1290–302. doi: 10.1038/ki.2013.491

PubMed Abstract | CrossRef Full Text | Google Scholar

6. Wong CW, Lamoureux EL, Cheng CY, Cheung GC, Tai ES, Wong TY, et al. Increased burden of vision impairment and eye diseases in persons with chronic kidney disease - a population-based study. EBioMedicine. (2016) 5:193–7. doi: 10.1016/j.ebiom.2016.01.023

PubMed Abstract | CrossRef Full Text | Google Scholar

7. Liu YT, Hung TY, Lee YK, Huang MY, Hsu CY, Su YC. Association between chronic kidney disease and risk of cataract: a nationwide retrospective cohort study. Am J Nephrol. (2017) 45:524–31. doi: 10.1159/000475555

PubMed Abstract | CrossRef Full Text | Google Scholar

8. Lee MR, Ke HL, Huang JC, Huang SP, Geng JH. Obesity-related indices and its association with kidney stone disease: a cross-sectional and longitudinal cohort study. Urolithiasis. (2022) 50:55–63. doi: 10.1007/s00240-021-01288-w

PubMed Abstract | CrossRef Full Text | Google Scholar

9. Chen CH, Lee JI, Jhan JH, Lee YC, Geng JH, Chen SC, et al. Secondhand smoke increases the risk of developing kidney stone disease. Sci Rep. (2021) 11:17694. doi: 10.1038/s41598-021-97254-y

PubMed Abstract | CrossRef Full Text | Google Scholar

10. Chang CW, Ke HL, Lee JI, Lee YC, Jhan JH, Wang HS, et al. Metabolic syndrome increases the risk of kidney stone disease: a cross-sectional and longitudinal cohort study. J Pers Med. (2021) 11:1154. doi: 10.3390/jpm11111154

PubMed Abstract | CrossRef Full Text | Google Scholar

11. Chang JR, Koo E, Agrón E, Hallak J, Clemons T, Azar D, et al. Risk factors associated with incident cataracts and cataract surgery in the age-related eye disease study (Areds): areds report number 32. Ophthalmology. (2011) 118:2113–9. doi: 10.1016/j.ophtha.2011.03.032

PubMed Abstract | CrossRef Full Text | Google Scholar

12. Foster PJ, Wong TY, Machin D, Johnson GJ, Seah SK. Risk factors for nuclear, cortical and posterior subcapsular cataracts in the chinese population of singapore: the tanjong pagar survey. Br J Ophthalmol. (2003) 87:1112–20. doi: 10.1136/bjo.87.9.1112

PubMed Abstract | CrossRef Full Text | Google Scholar

13. Mukesh BN, Le A, Dimitrov PN, Ahmed S, Taylor HR, McCarty CA. Development of cataract and associated risk factors: the visual impairment project. Arch Ophthalmol. (2006) 124:79–85. doi: 10.1001/archopht.124.1.79

PubMed Abstract | CrossRef Full Text | Google Scholar

14. Azim SF, Akhter QS, Akter T, Farid F. Obesity and dyslipidemia: risk factors for development of senile cataract. J Bangladesh Soc Physiol. (2018) 13:29–34. doi: 10.3329/jbsp.v13i1.37846

CrossRef Full Text | Google Scholar

15. Drews RC. Alcohol and cataract. Arch Ophthalmol. (1993) 111:1312. doi: 10.1001/archopht.1993.01090100018002

PubMed Abstract | CrossRef Full Text | Google Scholar

16. Yu X, Lyu D, Dong X, He J, Yao K. Hypertension and risk of cataract: a meta-analysis. PLoS ONE. (2014) 9:e114012. doi: 10.1371/journal.pone.0114012

PubMed Abstract | CrossRef Full Text | Google Scholar

17. Alharbi AMD, Alhazmi AMS. Prevalence, risk factors, and patient awareness of diabetic retinopathy in saudi arabia: a review of the literature. Cureus. (2020) 12:e11991. doi: 10.7759/cureus.11991

PubMed Abstract | CrossRef Full Text | Google Scholar

18. Delcourt C, Dupuy AM, Carriere I, Lacroux A, Cristol JP. Albumin and transthyretin as risk factors for cataract: the pola study. Arch Ophthalmol. (2005) 123:225–32. doi: 10.1001/archopht.123.2.225

PubMed Abstract | CrossRef Full Text | Google Scholar

19. Sharon Y, Schlesinger N. Beyond joints: a review of ocular abnormalities in gout and hyperuricemia. Curr Rheumatol Rep. (2016) 18:37. doi: 10.1007/s11926-016-0586-8

PubMed Abstract | CrossRef Full Text | Google Scholar

20. Klein BE, Klein R, Lee KE. Renal function abnormalities and incident cataract after a five-year interval: the beaver dam eye study. Curr Eye Res. (1998) 17:720–5. doi: 10.1080/02713689808951248

PubMed Abstract | CrossRef Full Text | Google Scholar

21. Huynh SC, Kifley A, Strippoli GF, Mitchell P. Is renal impairment a predictor of the incidence of cataract or cataract surgery? findings from a population-based study. Ophthalmology. (2005) 112:293–300. doi: 10.1016/j.ophtha.2004.09.014

PubMed Abstract | CrossRef Full Text | Google Scholar

22. Klein BE, Knudtson MD, Brazy P, Lee KE, Klein R. Cystatin C, other markers of kidney disease, and incidence of age-related cataract. Arch Ophthalmol. (2008) 126:1724–30. doi: 10.1001/archophthalmol.2008.502

PubMed Abstract | CrossRef Full Text | Google Scholar

23. Rim TH, Yoon CY, Park HW, Chung EJ. Association between starting hemodialysis for end-stage renal disease and incident cataract surgery: a 12-year nationwide cohort study. Invest Ophthalmol Vis Sci. (2016) 57:1112–9. doi: 10.1167/iovs.15-18276

PubMed Abstract | CrossRef Full Text | Google Scholar

24. Praveen MR, Shah GD, Vasavada AR, Mehta PG, Gilbert C, Bhagat G, et al. Study to explore the risk factors for the early onset of cataract in India. Eye. (2010) 24:686–94. doi: 10.1038/eye.2009.137

PubMed Abstract | CrossRef Full Text | Google Scholar

25. Jyothi R, Sathyan S. Etiopathogenesis of presenile cataracts in central kerala: a cross-sectional observational study. Kerala J Ophthalmol. (2017) 29:179–83. doi: 10.4103/kjo.kjo_102_17

CrossRef Full Text | Google Scholar

26. Wang W, Shang X, Zhang L, Li L, He M. Risk factors for early-onset cataracts treated surgically in Australian adults. Investig Ophthalmol Vis Sci. (2018) 59:3795.

Google Scholar

27. Klein BE, Klein R, Wang Q, Moss SE. Older-Onset diabetes and lens opacities. the beaver dam eye study. Ophthalmic Epidemiol. (1995) 2:49–55. doi: 10.3109/09286589509071451

PubMed Abstract | CrossRef Full Text | Google Scholar

28. Klein BE, Klein R, Moss SE. Incidence of cataract surgery in the wisconsin epidemiologic study of diabetic retinopathy. Am J Ophthalmol. (1995) 119:295–300. doi: 10.1016/S0002-9394(14)71170-5

PubMed Abstract | CrossRef Full Text | Google Scholar

29. Saxena S, Mitchell P, Rochtchina E. Five-year incidence of cataract in older persons with diabetes and pre-diabetes. Ophthalmic Epidemiol. (2004) 11:271–7. doi: 10.1080/09286580490510733

PubMed Abstract | CrossRef Full Text | Google Scholar

30. Drinkwater JJ, Davis WA, Davis TME. A systematic review of risk factors for cataract in type 2 diabetes. Diabetes Metab Res Rev. (2019) 35:e3073. doi: 10.1002/dmrr.3073

PubMed Abstract | CrossRef Full Text | Google Scholar

31. Kiziltoprak H, Tekin K, Inanc M, Goker YS. Cataract in diabetes mellitus. World J Diabetes. (2019) 10:140–53. doi: 10.4239/wjd.v10.i3.140

PubMed Abstract | CrossRef Full Text | Google Scholar

32. Hiller R, Sperduto RD, Reed GF, D'Agostino RB, Wilson PW. Serum lipids and age-related lens opacities: a longitudinal investigation: the framingham studies. Ophthalmology. (2003) 110:578–83. doi: 10.1016/S0161-6420(02)01762-1

PubMed Abstract | CrossRef Full Text | Google Scholar

33. Tung TH, Liu JH, Lee FL, Chen SJ, Tsai CY, Chou P. Community-based study of cataracts among type 2 diabetics in Kinmen. Eur J Epidemiol. (2005) 20:435–41. doi: 10.1007/s10654-004-7537-9

PubMed Abstract | CrossRef Full Text | Google Scholar

34. Becker C, Schneider C, Aballéa S, Bailey C, Bourne R, Jick S, et al. Cataract in patients with diabetes mellitus-incidence rates in the uk and risk factors. Eye. (2018) 32:1028–35. doi: 10.1038/s41433-017-0003-1

PubMed Abstract | CrossRef Full Text | Google Scholar

35. Srinivasan S, Raman R, Swaminathan G, Ganesan S, Kulothungan V, Sharma T. Incidence, progression, and risk factors for cataract in type 2 diabetes. Invest Ophthalmol Vis Sci. (2017) 58:5921–9. doi: 10.1167/iovs.17-22264

PubMed Abstract | CrossRef Full Text | Google Scholar

36. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (Ukpds 35): prospective observational study. BMJ. (2000) 321:405–12. doi: 10.1136/bmj.321.7258.405

PubMed Abstract | CrossRef Full Text | Google Scholar

37. Kostis JB, Dobrzynski JM. Prevention of cataracts by statins: a meta-analysis. J Cardiovasc Pharmacol Ther. (2014) 19:191–200. doi: 10.1177/1074248413511690

PubMed Abstract | CrossRef Full Text | Google Scholar

38. Berlyne GM, Ari JB, Danovitch GM, Blumenthal M. Cataracts of chronic renal failure. Lancet. (1972) 1:509–11. doi: 10.1016/S0140-6736(72)90175-4

PubMed Abstract | CrossRef Full Text | Google Scholar

39. Franke S, Dawczynski J, Strobel J, Niwa T, Stahl P, Stein G. Increased levels of advanced glycation end products in human cataractous lenses. J Cataract Refract Surg. (2003) 29:998–1004. doi: 10.1016/S0886-3350(02)01841-2

PubMed Abstract | CrossRef Full Text | Google Scholar

40. Nagaraj RH, Linetsky M, Stitt AW. The pathogenic role of maillard reaction in the aging eye. Amino Acids. (2012) 42:1205–20. doi: 10.1007/s00726-010-0778-x

PubMed Abstract | CrossRef Full Text | Google Scholar

41. Khoza LB, Nunu WN, Tshivhase SE, Murwira TS, Mambanga P, Ramakuela NJ, et al. Survey on prevalence of cataract in selected communities in limpopo province of South Africa. Sci Afr. (2020) 8:e00352. doi: 10.1016/j.sciaf.2020.e00352

CrossRef Full Text | Google Scholar

42. Gothwal VK, Wright TA, Lamoureux EL, Lundström M, Pesudovs K. Catquest questionnaire: re-validation in an australian cataract population. Clin Experiment Ophthalmol. (2009) 37:785–94. doi: 10.1111/j.1442-9071.2009.02133.x

PubMed Abstract | CrossRef Full Text | Google Scholar

43. Stocks N, Patel R, Sparrow J, Davey-Smith G. Prevalence of cataract in the speedwell cardiovascular study: a cross-sectional survey of men aged 65–83. Eye. (2002) 16:275–80. doi: 10.1038/sj.eye.6700106

PubMed Abstract | CrossRef Full Text | Google Scholar

44. Sullivan MK, Jani BD, McConnachie A, Hanlon P, McLoone P, Nicholl BI, et al. Hospitalisation events in people with chronic kidney disease as a component of multimorbidity: parallel cohort studies in research and routine care settings. BMC Med. (2021) 19:278. doi: 10.1186/s12916-021-02147-6

PubMed Abstract | CrossRef Full Text | Google Scholar

45. Geng T, Li X, Ma H, Heianza Y, Qi L. Adherence to a healthy sleep pattern and risk of chronic kidney disease: the uk biobank study. Mayo Clin Proc. (2022) 97:68–77. doi: 10.1016/j.mayocp.2021.08.028

PubMed Abstract | CrossRef Full Text | Google Scholar

46. Shiels A, Hejtmancik JF. Genetic origins of cataract. Arch Ophthalmol. (2007) 125:165–73. doi: 10.1001/archopht.125.2.165

PubMed Abstract | CrossRef Full Text | Google Scholar