The Association Between Reduced GFR and Hearing Loss: A Cross-sectional Population-Based Study

Background Chronic kidney disease (CKD) has long been associated with hearing loss in certain syndromes. Reported evidence to date has come from only small observational studies. We present the first community-based study to show an association between nonsyndromal CKD and hearing loss. Study Design Cross-sectional population-based study to examine the relationship between CKD and age-related hearing loss. Setting & Participants The Blue Mountains Hearing Study is a survey of age-related hearing loss conducted in 1997-2004; a total of 2,564 participants had audiometric testing and complete renal data. Predictor or Factor Moderate CKD, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Outcomes Bilateral hearing loss, defined as average pure-tone threshold >25 dB for measurements at frequencies of 0.5, 1.0, 2.0, and 4.0 kHz. Measurements Baseline biochemistry tests, including serum creatinine, were performed. Pure-tone audiometry was performed in sound-treated booths. Results Moderate CKD was present in 513 of 2,564 participants. Of persons with moderate CKD, 279 (54.4%) had measured hearing loss compared with 581 (28.3%) with eGFR ≥60 mL/min/1.73 m2. Moderate CKD was independently associated with hearing loss (OR, 1.43; 95% CI, 1.10-1.84; P = 0.006) after adjusting for age; sex; noise exposure; education; diabetes, hypertension, and stroke histories; and smoking. Participants with eGFR <45 mL/min/1.73 m2 had the highest prevalence of hearing loss (73%) compared with those with eGFR ≥90 mL/min/1.73 m2 (19%; multivariate adjusted OR, 2.4 [95% CI, 1.3-4.5]). Analyses were repeated after excluding participants reporting furosemide use (a known ototoxic agent); the association between moderate CKD and hearing loss remained significant (multivariate adjusted OR, 1.40 [95% CI, 1.08-1.83]; P = 0.01). Limitations The present study is not longitudinal and does not permit causal inference from the observed associations. Conclusions Moderate CKD per se was associated independently with hearing loss. Recognizing this link could lead to earlier hearing assessment with appropriate interventions to preserve the hearing of patients with CKD. Am J Kidney Dis 00:00-00 © 2010 by the National Kidney Foundation, Inc Chronic kidney disease (CKD) has long been associated with hearing loss in certain syndromes. Reported evidence to date has come from only small observational studies. We present the first community-based study to show an association between nonsyndromal CKD and hearing loss. Cross-sectional population-based study to examine the relationship between CKD and age-related hearing loss. The Blue Mountains Hearing Study is a survey of age-related hearing loss conducted in 1997-2004; a total of 2,564 participants had audiometric testing and complete renal data. Moderate CKD, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Bilateral hearing loss, defined as average pure-tone threshold >25 dB for measurements at frequencies of 0.5, 1.0, 2.0, and 4.0 kHz. Baseline biochemistry tests, including serum creatinine, were performed. Pure-tone audiometry was performed in sound-treated booths. Moderate CKD was present in 513 of 2,564 participants. Of persons with moderate CKD, 279 (54.4%) had measured hearing loss compared with 581 (28.3%) with eGFR ≥60 mL/min/1.73 m2. Moderate CKD was independently associated with hearing loss (OR, 1.43; 95% CI, 1.10-1.84; P = 0.006) after adjusting for age; sex; noise exposure; education; diabetes, hypertension, and stroke histories; and smoking. Participants with eGFR <45 mL/min/1.73 m2 had the highest prevalence of hearing loss (73%) compared with those with eGFR ≥90 mL/min/1.73 m2 (19%; multivariate adjusted OR, 2.4 [95% CI, 1.3-4.5]). Analyses were repeated after excluding participants reporting furosemide use (a known ototoxic agent); the association between moderate CKD and hearing loss remained significant (multivariate adjusted OR, 1.40 [95% CI, 1.08-1.83]; P = 0.01). The present study is not longitudinal and does not permit causal inference from the observed associations. Moderate CKD per se was associated independently with hearing loss. Recognizing this link could lead to earlier hearing assessment with appropriate interventions to preserve the hearing of patients with CKD. Am J Kidney Dis 00:00-00 © 2010 by the National Kidney Foundation, Inc