Vision-Related Quality of Life in Adults with Chronic Kidney Disease: A Population-Based Study

• CKD was associated with poorer mobility, reading, and emotional VRQoL • VRQoL declined progressively across advancing CKD stages • CKD was associated with vision impairment Chronic kidney disease (CKD) a major global health concern has been shown to be associated with VI, but its impact on vision-related quality of life (VRQoL) is less well characterised. We examined the association of presence and severity of CKD with VRQoL in a multi-ethnic Asian population. Population-based, cross-sectional study 7,122 adults aged 40-80 years (51.2% female) who participated in the Singapore Epidemiology of Eye Diseases (2009-2015). CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² and severity categorized as G1-G2 (≥60), G3 (30-59), G4 (15-29), and G5 (<15). VI was defined as best-corrected visual acuity worse than 20/40 in the better-seeing eye. VRQoL was assessed using Rasch-scaled scores from the Reading, Mobility, and Emotional domains of the Impact of Vision Impairment questionnaire. Multivariable linear and logistic regression models adjusted for sociodemographic and clinical factors were used to examine associations of CKD with VRQoL scores and VI, and of VI with VRQoL in those with CKD. VRQoL scores (mobility, reading, and emotional well-being domains); VI (secondary). Compared to participants without CKD, those with, had higher prevalence of VI (12.7% Vs. 36.4%) and poorer VRQoL scores across the three domains (all p<0.001). In multivariable models, CKD was significantly associated with poorer VRQoL scores with β (95% CI) of -0.50 (-0.61, -0.39) for mobility, -0.44 (-0.56, -0.32) for reading ability and -0.34 (-0.46, -0.22) for emotional well-being. A clear dose–response relationship was observed, with progressively worse VRQoL across advancing CKD stages for all three domains (p-trend<0.001). In secondary analyses, CKD was significantly associated with VI (adjusted odds ratio = 1.23, 95% CI 1.00–1.51) and VI was associated with poorer VRQoL in those with CKD (p<0.001 in all three domains). CKD was significantly associated with poorer VRQoL across key functional and emotional domains, with deficits worsening across advancing CKD stages as well as with a higher likelihood of VI. These findings support the integration of vision assessment and eye care into CKD management to preserve daily functioning, emotional well-being, and QoL.