Glomerular Filtration Rate and Urine Albumin to Creatinine Ratio Associated With Hearing Impairment Among Korean Adults With Diabetes

Abstract

The objective of this study was to examine the association of estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (ACR) with hearing impairment among diabetic adults in Korea. The study was based on data from Korea National Health and Nutrition Examination Survey 2011 to 2012. Participants were 1206 diabetic adults, aged over 19 years, who completed audiometric testing supervised by nationally certified clinicians. Hearing impairment was defined in three grades: no hearing impairment (pure-tone average 0–25 dB), slight hearing impairment (26–40 dB), and disabling hearing impairment (>40 dB) in the better ear at frequencies 0.5, 1, 2, 3, 4 and 6 kHz. Using logistic regression, risk of hearing impairment was assessed after having controlled for confounding factors. Higher levels of ACR and lower levels of eGFR correlated with an increase in percentage of disabling hearing impairment both unilaterally and bilaterally (P < 0.001). Controlling for possible confounding covariates, odds ratios for hearing impairment showed tendency to increase in higher ACR groups (P for trend = 0.029). Similar pattern was examined between eGFR and hearing impairment (P for trend = 0.006). Odds ratios were 1.981 (1.146, 3.424) for ACR Q4 and 2.773 (1.286, 5.983) for eGFR < 60 mL/min. Fall in eGFR and rise in ACR correlated with severity of hearing impairment. The association existed independently of age, sex, body mass index (BMI), smoking, drinking, exercise, new onset of diabetes, education, income, mental stress, noise exposure, and metabolic syndrome.

Risk factors for hearing impairment among adults with diabetes: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

“…We used estimated glomerular filtration rate as the indicator of renal function and demonstrated that loss of hearing sensitivity is apparent at earlier stages of chronic kidney disease. This observation adds to recent evidence from Korea where mild chronic kidney disease (eGFR 60–90 mL/min/1.73 m 2 ) was associated with more severe hearing impairment [30] . Independent of diabetes, estimated glomerular filtration rate less than 60 mL/min/1.73 m 2 has been associated with hearing loss of mild severity in population-based studies conducted in Australia and Korea [10] , [31] .…”

Relationships between dipstick proteinuria and risk of hearing impairment among Japanese workers: a prospective cohort study

“…In a previous study in Korea, subjects with albuminuria and low-grade albuminuria had a higher prevalence of moderate to profound HI overall and at low/middle and high frequencies 14. Another study in Korea also showed that urine albumin creatinine ratio was positively associated with the prevalence of HI at low, middle and high frequencies and with the average hearing threshold,15 and a third study in Korea showed that urine albumin creatinine ratio and lower estimated glomerular filtration rate as CKD stage 3 or more were positively associated with the prevalence of HI 16. In a previous study, we found that the degree of dipstick proteinuria was positively associated with the prevalence of total moderate HI, moderate HI at 1 kHz, and moderate HI at 4 kHz 18.…”

“…To our knowledge, no previous prospective cohort study has examined the association between proteinuria and the risk of HI. Several cross-sectional studies have examined the associations of albuminuria, low-grade albuminuria, urine albumin creatinine ratio, dipstick proteinuria, and CKD with the prevalence of HI 14–16. In a previous study in Korea, subjects with albuminuria and low-grade albuminuria had a higher prevalence of moderate to profound HI overall and at low/middle and high frequencies 14.…”

“…Recently, a study in Taiwan showed that patients with end-stage renal disease had a higher risk of sudden sensorineural hearing loss, compared with controls 13. Additionally, several epidemiological studies have reported that symptoms of renal injury, such as albuminuria, low-grade albuminuria, high urine albumin creatinine ratio, dipstick proteinuria, low estimated glomerular filtration rate and chronic kidney disease (CKD), were associated with higher risk of HI 14–16. However, these studies have been unable to establish cause–effect relationships because of the studies’ cross-sectional designs.…”

Association between the severity of hearing loss and the risk of dementia within the 2010–2017 national insurance service survey in South Korea

“…Recently, several nationwide studies with large-scale, long-term follow-up designs have been published from South Korea 9 , 10 . South Korea has several advantages for conducting a nationwide study that addresses the association between HL and dementia risk: the territory is relatively small; it benefits from excellent transportation to accessible medical services, and the national population is registered with the National Health Insurance Service, with all medical data being well-organized in their respective National Health Information Database (NHID).…”