title: The association between reduced GFR and hearing loss: a cross-sectional population-based study.
abstract: 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.
  
  
  METHODS
  Cross-sectional population-based study to examine the relationship between CKD and age-related hearing loss.
  
  
  METHODS
  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.
  
  
  METHODS
  Moderate CKD, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2).
  
  
  RESULTS
  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.
  
  
  METHODS
  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 m(2). 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 m(2) had the highest prevalence of hearing loss (73%) compared with those with eGFR ≥90 mL/min/1.73 m(2) (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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Transplantation and Renal Research, Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, New South Wales, Sydney, Australia.
authors.forename: Eswari
authors.initials: E
authors.lastname: Vilayur
authors.forename: Bamini
authors.initials: B
authors.lastname: Gopinath
authors.forename: David C
authors.initials: DC
authors.lastname: Harris
authors.forename: George
authors.initials: G
authors.lastname: Burlutsky
authors.forename: Catherine M
authors.initials: CM
authors.lastname: McMahon
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
mesh_terms: D017677:Age Distribution; D000368:Aged; D001301:Audiometry, Pure-Tone; D015897:Comorbidity; D016001:Confidence Intervals; D003404:Creatinine / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D034381:Hearing Loss / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009517:New South Wales / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D011795:Surveys and Questionnaires
chemical_list: D003404:Creatinine