Features Of Cataract Development In Patients With End-Stage Non-Diabetic Chronic Kidney Disease

This study aims to examine the features of cataract development in patients with end-stage non-diabetic chronic kidney disease (CKD). It analyzes factors contributing to cataract progression in this patient group, including metabolic disorders, calcium-phosphorus metabolism disturbances, and the impact of prolonged hemodialysis. The primary focus is on identifying specific mechanisms of cataractogenesis in patients with end-stage CKD and exploring potential approaches for prevention and early diagnosis.

The study was conducted in specialized centers: Republican Specialized Scientific and Practical Medical Center of Eye Microsurgery and Republican Specialized Scientific and Practical Medical Center of Surgery named after Academician V.V. Vakhidov in Tashkent - where patients with end-stage non-diabetic CKD underwent examination and treatment. 

An observational cohort study was conducted, with patients being followed for four years. The study included three groups: Patients with end-stage non-diabetic CKD (54 patients, 108 eyes); Patients with end-stage diabetic CKD (50 patients, 100 eyes); Patients without CKD (48 patients, 96 eyes). Cataract diagnosis was performed using biomicroscopy, ophthalmoscopy, ultrasound biometry, and optical coherence tomography. Biochemical parameters were assessed by analyzing urea, creatinine, calcium, and phosphorus levels. The influence of hemodialysis duration was evaluated using correlation and regression analysis.

Patients with end-stage diabetic CKD on hemodialysis had the highest risk of cataract development, with a hemodialysis duration of more than five years increasing the risk by 2.6 times. Patients with end-stage non-diabetic CKD on hemodialysis had a lower but still increased risk of cataract development, with long-term hemodialysis increasing the risk by 1.7 times. The primary predisposing factors were tissue calcification due to calcium-phosphorus metabolism disturbances and osmotic imbalance. Analysis also revealed that diabetes and long-term hypertension significantly contributed to accelerated cataract progression.

End-stage CKD, particularly with prolonged hemodialysis, is a significant risk factor for rapid cataract progression. The main mechanisms of cataractogenesis include the accumulation of uremic toxins, metabolic acidosis, oxidative stress, and lens calcification. The findings highlight the need for early ophthalmologic screening in patients with end-stage CKD and the development of strategies to correct metabolic disorders to slow cataract progression.