Increased risk of tinnitus in patients with chronic kidney disease: A nationwide, population-based cohort study

Shih, Cheng‐Ping; Lin, Hung‐Che; Chung, Chi‐Hsiang; Hsiao, Po-Jen; Wang, Chih‐Hung; Lee, Jih‐Chin; Chien, Wu-Chien

doi:10.1371/journal.pone.0183192

Cited by 20 publications

(36 citation statements)

References 37 publications

(41 reference statements)

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“…It was mainly diagnosed in long-lasting CKD patients and deteriorated over time [7,8]. It was reported that the highest prevalence of SNHL occurred in individuals with estimated glomerular filtration rate (eGFR) above 45 ml/min/1.73 m 2 [9].…”

Section: Sensorineural Hearing Loss (Snhl)mentioning

confidence: 99%

“…Hearing dysfunction SNHL 28-77% of patients with CKD are affected [7,8] It might result from several structural and functional similarities in kidney and in inner ear, as well as similar antigenicity [8] Potential mechanisms leading to SNHL in CKD Electrolyte disturbances [6] Elevated serum urea and creatinine levels [6] Treatment (ototoxic drugs: aminoglycosides and furosemide, HD itself and prolonged treatment duration) [6,8] Coexisting hypertension or DM [6] Vitamin D deficiency and reduction of Na+ K+ activated ATPase [8] Endolymphatic edema [8] Uremia-induced dysfunctions in nervous system, called "uremic neuropathy" leading to auditory nerve and hearing pathway alterations [8] Formation of amyloid collections in the cochlea induced by permanent HD [8] Toxic influence of aluminum on inner ear [8] SNHL in CKD is usually bilateral and mainly affects high frequencies [8] Speech discrimination seems not to be affected in these patients [8] DPOAE are reduced or absent, and might detect subclinical cochlear dysfunction in CKD [10] ABR tests might reveal lower neural auditory conduction defined by prolongation of ABR waves [11] ABR test might be improved after HD sessions (potentially because of Ca++ ions and urea changes after HD), nevertheless hearing never return to normal [11] SSNHL 1.57-times higher than in GP [12] Mechanism is unknown Worse prognosis of recovery than in non-CKD patients while undergoing systemic steroid therapy for SSNHL [12] Promising treatment results after intratympanic steroid injections in these patients [12] Tinnitus 3.02-times higher in CKD than in GP [9] 4.586-higher in CKD on HD than in GP [9] Mechanism is unclear…”

Section: Additional Informationmentioning

confidence: 99%

“…Might be an effect of downregulation of intracortical suppression that is linked to the cochlear damage [9] Commonly coexisting with SNHL Oropharyngeal changes Xerostomia 28.2-91% of patients with CKD are affected (higher with coexisting DM) [19,20,24] Results from dehydration, reduced saliva flow and urea-induced changes in salivary gland morphology (fibrosis and atrophy) [21] In patients with CKD saliva flow is 20-55% reduced [20] Cases with no measurable saliva flow are also present in these patients [20] Dysgeusia 43-90% of patients with CKD are affected [19,25] Exact mechanism is unknown It might emerge from the influence of uremic toxins on both, the central nervous system and on the teste receptors located in the peripheral nervous system [17]. High levels of urea, dimethyl and trimethylamine in saliva, reduced saliva production, altered saliva composition, reduced number of taste buds, metabolic disorders, and drugs used in treatment (mainly antihypertensive agents) play a role [17] Commonly accompanied with "metallic taste"; sour and sweet tastes might be more significantly affected than salty and bitter tastes [17] Halitosis 91% of patients with CKD not on HD; 90% of patients with CKD on HD are affected [25] Results from high urea levels (above 55 mg/dl) Alkaline nature of urea and ammonia maintain increased pH levels of saliva promoting bacteria development and unpleasant odor from oral cavity [23] Increased risk of dental calculus formation and reduced risk of caries because of alkaline saliva pH [23] Sore throat Higher than in GP * [17] Might be a consequence of reduced saliva production, dehydration and urea decomposing commensal bacteria [17] Mucosal ulceration 8.6% of patients with ESKD 1.3% of RTRs [16] Might be a consequence of reduced saliva production, dehydration and urea decomposing commensal bacteria [17] [23] It mainly results from drug-induced changes in gingival fibroblasts and lamina propria that lead to formation of deposits of the intercellular matrix and increase in vascularity [26] In patients in pre-dialysis or HD stage of CKD it is mainly induced by calcium channel blockers, while in RTRs by cyclosporine [26] Lichenoid changes/leukoplakia 8-11% of RTRs are affected [27] Mechanism is unknown Might be a result of drug-induced reactivation of EBV in the oral epithelium [28] Negative EBV cases were also pres...…”

Section: Additional Informationmentioning

confidence: 99%

“…Tinnitus is a perception of the sound in the absence of auditory stimulus from the outside, and is mainly a result of auditory pathology [9]. It might be a coexisting symptom in SNHL [7].…”

Section: Tinnitusmentioning

confidence: 99%

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Otorhinolaryngological dysfunctions induced by chronic kidney disease in pre- and post-transplant stages

Wojciechowska

Krajewski

Zatoński

2020

Eur Arch Otorhinolaryngol

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Purpose Otorhinolaryngological abnormalities are common complications of chronic kidney disease (CKD) and its treatment. The main aim of this study was to provide a brief and precise review of the current knowledge regarding CKD and its treatment-related influence on head and neck organs. Methods The Medline and Web of Science databases were searched using the terms "chronic kidney disease", "kidney transplantation", "immunosuppression", "dialysis" in conjunction with "otorhinolaryngological manifestation". Articles that did not address the topics, low-quality studies, case reports, and studies based on nonsignificant cohorts were excluded, and the full text of remaining high-quality, novel articles were examined and elaborated on. Results Patients with CKD are prone to develop sensorineural hearing loss, tinnitus, recurrent epistaxis, opportunistic infections including oropharyngeal candidiasis or rhino-cerebral mucormycosis, taste and smell changes, phonatory and vestibular dysfunctions, deep neck infections, mucosal abnormalities, gingival hyperplasia, halitosis or xerostomia. Immunosuppressive therapy after kidney transplantation increases the risk of carcinogenesis, both related and not-related to latent viral infection. The most commonly viral-related neoplasms observed in these patients are oral and oropharyngeal cancers, whereas the majority of not-related to viral infection tumors constitute lip and thyroid cancers. CKD-related otorhinolaryngological dysfunctions are often permanent, difficult to control, have a significant negative influence on patient's quality of life, and can be life threatening. Conclusion Patients with CKD suffer from a number of otorhinolaryngological CKD-induced complications. The relationship between several otorhinolaryngological complications and CKD was widely explained, whereas the correlation between the rest of them and CKD remains unclear. Further studies on this subject are necessary.

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Section: Sensorineural Hearing Loss (Snhl)mentioning

confidence: 99%

Section: Additional Informationmentioning

confidence: 99%

Section: Additional Informationmentioning

confidence: 99%

“…Tinnitus is a perception of the sound in the absence of auditory stimulus from the outside, and is mainly a result of auditory pathology [9]. It might be a coexisting symptom in SNHL [7].…”

Section: Tinnitusmentioning

confidence: 99%

See 2 more Smart Citations

Otorhinolaryngological dysfunctions induced by chronic kidney disease in pre- and post-transplant stages

Wojciechowska

Krajewski

Zatoński

2020

Eur Arch Otorhinolaryngol

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“…6 Tinnitus can be accompanied by otological, metabolic, orthopedic, cardiovascular, neurological, dental, and pharmacological conditions. 9 Currently, the treatment methods for tinnitus mainly include counseling, tinnitus maskers, cognitive behavioral therapy, and hearing aids to reduce the distress associated with tinnitus. 7 Despite in Chinese medicine, kidney disease is considered to be associated with tinnitus, 8 the relationship between tinnitus and kidney diseases is rarely reported in modern medicine.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Chinese herb Cistanche Yishen granules in treatment of tinnitus for patients with chronic nephritis

Fan

Chen

et al. 2018

J of Cellular Biochemistry

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Objective This study aimed to investigate the efficacy of Chinese herb Cistanche Yishen granules (CYG) in the treatment of tinnitus for patients with chronic nephritis. Methods A total of 89 adult patients were diagnosed with chronic glomerulonephritis from January 2016 to December 2017. All the patients were randomly divided into two groups, such as the control group and the CYG group. The efficacy of tinnitus was determined using tinnitus handicap inventory (THI), Pittsburgh sleep quality index (PSQI), pure tone audiometry (PTA), speech reception threshold (SRT), and visual analog scale (VAS) for tinnitus loudness and annoyance. Results In both these two groups of patients, values of THI, PSQI, PTA, SRT, and VAS for tinnitus loudness and annoyance were significantly decreased after the treatment compared with those before treatment. However, all values in CYG group after the treatment were significantly lower than those in the control group. Conclusion CYG could apparently release the tinnitus symptoms in the patients with chronic nephritis. This study might give more clinical evidence for Cistanche in the treatment of tinnitus and give a new treatment method for the patients with tinnitus.

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Hypertension and Kidney Function After Living Kidney Donation

Garg,

Arnold,

Cuerden

et al. 2024

JAMA

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ImportanceRecent guidelines call for better evidence on health outcomes after living kidney donation.ObjectiveTo determine the risk of hypertension in normotensive adults who donated a kidney compared with nondonors of similar baseline health. Their rates of estimated glomerular filtration rate (eGFR) decline and risk of albuminuria were also compared.Design, Setting, and ParticipantsProspective cohort study of 924 standard-criteria living kidney donors enrolled before surgery and a concurrent sample of 396 nondonors. Recruitment occurred from 2004 to 2014 from 17 transplant centers (12 in Canada and 5 in Australia); follow-up occurred until November 2021. Donors and nondonors had the same annual schedule of follow-up assessments. Inverse probability of treatment weighting on a propensity score was used to balance donors and nondonors on baseline characteristics.ExposureLiving kidney donation.Main Outcomes and MeasuresHypertension (systolic blood pressure [SBP] ≥140 mm Hg, diastolic blood pressure [DBP] ≥90 mm Hg, or antihypertensive medication), annualized change in eGFR (starting 12 months after donation/simulated donation date in nondonors), and albuminuria (albumin to creatinine ratio ≥3 mg/mmol [≥30 mg/g]).ResultsAmong the 924 donors, 66% were female; they had a mean age of 47 years and a mean eGFR of 100 mL/min/1.73 m2. Donors were more likely than nondonors to have a family history of kidney failure (464/922 [50%] vs 89/394 [23%], respectively). After statistical weighting, the sample of nondonors increased to 928 and baseline characteristics were similar between the 2 groups. During a median follow-up of 7.3 years (IQR, 6.0-9.0), in weighted analysis, hypertension occurred in 161 of 924 donors (17%) and 158 of 928 nondonors (17%) (weighted hazard ratio, 1.11 [95% CI, 0.75-1.66]). The longitudinal change in mean blood pressure was similar in donors and nondonors. After the initial drop in donors’ eGFR after nephrectomy (mean, 32 mL/min/1.73 m2), donors had a 1.4-mL/min/1.73 m2 (95% CI, 1.2-1.5) per year lesser decline in eGFR than nondonors. However, more donors than nondonors had an eGFR between 30 and 60 mL/min/1.73 m2 at least once in follow-up (438/924 [47%] vs 49/928 [5%]). Albuminuria occurred in 132 of 905 donors (15%) and 95 of 904 nondonors (11%) (weighted hazard ratio, 1.46 [95% CI, 0.97-2.21]); the weighted between-group difference in the albumin to creatinine ratio was 1.02 (95% CI, 0.88-1.19).Conclusions and RelevanceIn this cohort study of living kidney donors and nondonors with the same follow-up schedule, the risks of hypertension and albuminuria were not significantly different. After the initial drop in eGFR from nephrectomy, donors had a slower mean rate of eGFR decline than nondonors but were more likely to have an eGFR between 30 and 60 mL/min/1.73 m2 at least once in follow-up.Trial RegistrationClinicalTrials.gov Identifier: NCT00936078

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Increased risk of tinnitus in patients with chronic kidney disease: A nationwide, population-based cohort study

Cited by 20 publications

References 37 publications

Otorhinolaryngological dysfunctions induced by chronic kidney disease in pre- and post-transplant stages

Otorhinolaryngological dysfunctions induced by chronic kidney disease in pre- and post-transplant stages

Efficacy of Chinese herb Cistanche Yishen granules in treatment of tinnitus for patients with chronic nephritis

Hypertension and Kidney Function After Living Kidney Donation

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