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Risks Associated With Topical Carbonic Anhydrase Inhibitor Use in Patients With Glaucoma and Chronic Kidney Disease
TAKE-HOME MESSAGE
- An analysis of data extracted from the Taiwan National Health Insurance Research Database revealed that, in a cohort of patients with pre-dialysis stage 5 chronic kidney disease (CKD) and glaucoma, patients who were using topical carbonic anhydrase inhibitors (CAIs) had an increased risk of metabolic acidosis and renal progression compared with non-CAI–treated patients.
- Healthcare providers treating patients with advanced CKD and glaucoma should consider alternatives to topical CAI treatment or, if CAIs are used, should monitor renal function.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To investigate the risks of metabolic acidosis and renal outcomes after topical carbonic anhydrase inhibitor (CAI) use in patients with both primary open-angle glaucoma (POAG) and advanced chronic kidney disease (CKD).
DESIGN
Nation-wide, population-based cohort study.
METHODS
This study was conducted with population data from Taiwan's National Health Insurance (NHI) Research Database between January 2000 and June 2009. Patients with advanced CKD who were diagnosed with glaucoma (ICD-9 code 365) and had been receiving eye drops for glaucoma (including carbonic anhydrase inhibitors selected by NHI drug code) were enrolled. Using Kaplan-Meier methods, we compared the cumulative incidence of mortality, long term dialysis and the cumulative incidence of metabolic acidosis over time between CAI users and CAI non-users with the Kaplan-Meier method. Primary outcomes comprise mortality, renal outcome (progression to hemodialysis) and metabolic acidosis.
RESULTS
In this cohort, topical CAI users had higher incidence for long term dialysis than non-users (incidence 1,216.85 vs 764.17 events per 100 patient years; adjusted hazard ratio 1.17, 95% CI 1.01-1.37). Hospital admissions due to metabolic acidosis were higher in CAI users compared with non-users (incidence 21.54 vs 11.87 events per 100 patient-years; adjusted hazard ratio, 1.89, 95% CI 1.07-3.36).
CONCLUSIONS
Topical CAIs may be associated with higher risks of long term dialysis and metabolic acidosis in patients with POAG and pre-dialysis advanced CKD. Therefore, topical CAIs should be used with caution in advanced CKD patients.
Additional Info
Risks of Topical Carbonic Anhydrase Inhibitors in Glaucoma Patients with Chronic Kidney Disease: A Nationwide Population-Based Study
Am J Ophthalmol 2023 May 04;[EPub Ahead of Print], YC Wang, XC Ling, WH Tsai, JS Liu, KL KuoFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.