{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T03:24:42Z","timestamp":1776309882830,"version":"3.50.1"},"reference-count":28,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82000896"],"award-info":[{"award-number":["82000896"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004735","name":"Natural Science Foundation of Hunan Province","doi-asserted-by":"publisher","award":["2020JJ5896"],"award-info":[{"award-number":["2020JJ5896"]}],"id":[{"id":"10.13039\/501100004735","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,14]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Visual impairment (VI) and chronic kidney disease (CKD) are highly prevalent and associated with increased mortality risk separately. However, their combined effects on mortality risk are not well defined.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Longitudinal, population-based, cohort study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>A nationally representative sample of community-dwelling adults aged 45 and older in China at baseline was recruited from the China Health And Retirement Longitudinal Study (CHARLS).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>All the participants were classified into four groups based on the presence of CKD and VI. The primary outcome was all-cause mortality. Cox proportional-hazards regression analyses were used to determine the HRs of risk factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 15\u2009054 subjects were enrolled. The participants with CKD and VI showed the highest mortality rate (19.22%). The risk of all-cause mortality was significantly greater in participants with CKD and VI (HR: 1.174; 95%\u2009CI: 1.055 to 1.293) than in those without CKD or VI, after adjusting for other potential risk factors. Among participants over 70 years old, no significant difference in mortality rate was found among the four groups (all p&gt;0.05).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>CKD was a significant predictor for all-cause mortality, while VI was not an independent risk factor for long-term survival. Participants with VI and CKD were at an increased risk of all-cause mortality. The effects attenuated with age. Our results may reveal the underlying mechanism behind the VI\u2013CKD\u2013mortality association and reinforce the importance of preventing and treating CKD and VI to avoid premature mortality in middle-aged and older adults.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-098553","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T12:56:01Z","timestamp":1756904161000},"page":"e098553","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Combined effects of visual impairment and chronic kidney disease on all-cause mortality among middle-aged and older adults: a longitudinal, population-based cohort study in China"],"prefix":"10.1136","volume":"15","author":[{"given":"Hanyuan","family":"Ye","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Jingmen People\u2019s Hospital, Jingmen, Hubei, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3156-7064","authenticated-orcid":false,"given":"Ye","family":"He","sequence":"additional","affiliation":[{"name":"Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China"},{"name":"Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China"},{"name":"National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"2025090305551612000_15.9.e098553.1","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2021.100852","article-title":"Global economic productivity losses from vision impairment and blindness","volume":"35","author":"Marques","year":"2021","journal-title":"EClinicalMedicine"},{"key":"2025090305551612000_15.9.e098553.2","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1080\/09286586.2021.1918176","article-title":"A Systematic Review of the Proportion of Blindness in the Population 50 Years and Older from Total Population-Based Surveys of Blindness and Visual Impairment","volume":"29","author":"Mushumbusi","year":"2022","journal-title":"Ophthalmic Epidemiol"},{"key":"2025090305551612000_15.9.e098553.3","doi-asserted-by":"crossref","first-page":"e130","DOI":"10.1016\/S2214-109X(20)30425-3","article-title":"Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study","volume":"9","author":"Bourne","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2025090305551612000_15.9.e098553.4","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.3233\/JAD-210250","article-title":"Visual Impairment, Eye Diseases, and Dementia Risk: A Systematic Review and Meta-Analysis","volume":"83","author":"Ku\u017ama","year":"2021","journal-title":"J Alzheimers Dis"},{"key":"2025090305551612000_15.9.e098553.5","doi-asserted-by":"crossref","first-page":"e418","DOI":"10.1016\/S2214-109X(20)30549-0","article-title":"Association between vision impairment and mortality: a systematic review and meta-analysis","volume":"9","author":"Ehrlich","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2025090305551612000_15.9.e098553.6","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1038\/s41433-020-01226-x","article-title":"Visual impairment and ten-year mortality: the Liwan Eye Study","volume":"35","author":"Wang","year":"2021","journal-title":"Eye (Lond)"},{"key":"2025090305551612000_15.9.e098553.7","doi-asserted-by":"crossref","first-page":"e424","DOI":"10.1111\/aos.12370","article-title":"Ocular diseases and 10-year mortality: the Beijing Eye Study 2001\/2011","volume":"92","author":"Wang","year":"2014","journal-title":"Acta Ophthalmol"},{"key":"2025090305551612000_15.9.e098553.8","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1123\/jpah.2015-0692","article-title":"Sensory Impairment, Functional Balance and Physical Activity With All-Cause Mortality","volume":"13","author":"Loprinzi","year":"2016","journal-title":"J Phys Act Health"},{"key":"2025090305551612000_15.9.e098553.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.kisu.2021.11.003"},{"key":"2025090305551612000_15.9.e098553.10","doi-asserted-by":"crossref","unstructured":"Alfano G , Perrone R , Fontana F , et al . n.d. 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