{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T13:28:07Z","timestamp":1779110887229,"version":"3.51.4"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Science and Technology Council, Taiwan, R.O.C.","award":["MOST107-2320-B-039-049-MY3"],"award-info":[{"award-number":["MOST107-2320-B-039-049-MY3"]}]},{"name":"National Science and Technology Council, Taiwan, R.O.C.","award":["111-2314-B-039 -054-"],"award-info":[{"award-number":["111-2314-B-039 -054-"]}]},{"name":"National Science and Technology Council, Taiwan, R.O.C.","award":["111-2314-B-039 -053-MY3"],"award-info":[{"award-number":["111-2314-B-039 -053-MY3"]}]},{"name":"National Science and Technology Council, Taiwan, R.O.C.","award":["NSTC-112-2314-B-039-029"],"award-info":[{"award-number":["NSTC-112-2314-B-039-029"]}]},{"DOI":"10.13039\/501100004391","name":"China Medical University Hospital, Taichung, Taiwan","doi-asserted-by":"crossref","award":["DMR-112-012; DMR-112-103"],"award-info":[{"award-number":["DMR-112-012; DMR-112-103"]}],"id":[{"id":"10.13039\/501100004391","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Taichung Tzu Chi Hospital, Taichung, Taiwan","award":["TTCRD 111-14"],"award-info":[{"award-number":["TTCRD 111-14"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Age-related macular degeneration (AMD) and chronic kidney disease (CKD) are common causes of morbidity, with systemic risk factors shared. Clarifying the association between the two is crucial to guiding comprehensive management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to systematically review current and latest evidence on the influence of CKD on AMD prevalence. An investigation was performed into various AMD stages and how different CKD severities exert their effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>Databases of PubMed and Embase were searched from their inception to 11 November 2024. Reference lists of studies were reviewed, and relevant researchers were contacted. The study was accepted and registered with PROSPERO (CRD420250612669).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study selection<\/jats:title>\n                    <jats:p>Eligible studies of the current review are observational, peer-reviewed, and include quantitative comparisons of AMD prevalence between populations with and without CKD. Studies with overlapping data or investigating AMD incidence were excluded. Twenty studies met the inclusion criteria from the 3,218 initially identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data extraction and synthesis<\/jats:title>\n                    <jats:p>We extracted data and assessed study quality using the Appraisal tool for Cross-Sectional Studies (AXIS) tool for cross-sectional studies. Our meta-analyses followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and were conducted with Review Manager 5.4.1. Risk of bias was evaluated using the AXIS quality appraisal tool, and the overall certainty of evidence was qualitatively assessed following the GRADE approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcomes and measures<\/jats:title>\n                    <jats:p>Primary outcomes are the prevalence of all-stage, early-stage, and late-stage AMD among CKD and non-CKD patients. Secondary outcomes investigated AMD prevalence among patients with different CKD stages. We reported in our analyses the risk ratios (RRs) with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All-stage AMD prevalence was found to be higher among CKD patients (RR: 1.65; 95% CI: 1.49\u20131.83). Similarly, early-stage AMD was more prevalent among CKD patients (RR: 1.47; 95% CI: 1.26\u20131.71). In late-stage AMD, an even stronger association was shown (RR: 3.72; 95% CI: 2.14\u20136.45). Meanwhile, there was no significant difference in AMD prevalence between moderate and advanced CKD stages (RR: 1.08; 95% CI: 0.48\u20132.46).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion and relevance<\/jats:title>\n                    <jats:p>Our findings indicate that CKD is significantly associated with higher AMD prevalence. These findings suggest the effects of shared systemic mechanisms and underscore the need for ophthalmic screening in CKD patients. Further studies are needed to strengthen causality and expand generalizability beyond the Asian population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      The systematic review was registered in\n                      <jats:ext-link>PROSPERO<\/jats:ext-link>\n                      (CRD420250612669).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1635766","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T06:31:28Z","timestamp":1764225088000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Chronic kidney disease increases the risks of age-related macular degeneration: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"12","author":[{"given":"Ting-Han","family":"Lin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"You-Yen","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Te","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu-Chuen","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peng-Tai","family":"Tien","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Wan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui-Ju","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"ref1","volume-title":"Wet age-related macular degeneration (AMD)","author":"Hobbs","year":"2024"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e29583","DOI":"10.7759\/cureus.29583","article-title":"Age-related macular degeneration: epidemiology, pathophysiology, diagnosis, and treatment","volume":"14","author":"Vyawahare","year":"2022","journal-title":"Cureus"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1016\/j.ophtha.2023.12.030","article-title":"Is kidney function associated with age-related macular degeneration? Findings from the Asian eye epidemiology consortium","volume":"131","author":"Xue","year":"2024","journal-title":"Ophthalmology"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1111\/joim.12227","article-title":"Is age-related macular degeneration a manifestation of systemic disease? New prospects for early intervention and treatment","volume":"276","author":"Cheung","year":"2014","journal-title":"J Intern Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2592","DOI":"10.3390\/ijms23052592","article-title":"Exudative versus nonexudative age-related macular degeneration: physiopathology and treatment options","volume":"23","author":"Fernandes","year":"2022","journal-title":"Int J Mol Sci"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"100090","DOI":"10.1016\/j.apjo.2024.100090","article-title":"Latest developments of generative artificial intelligence and applications in ophthalmology","volume":"13","author":"Feng","year":"2024","journal-title":"Asia Pac J Ophthalmol (Phila)"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1053\/j.ajkd.2018.12.047","article-title":"Vision impairment in CKD patients: epidemiology, mechanisms, differential diagnoses, and prevention","volume":"73","author":"Nusinovici","year":"2019","journal-title":"Am J Kidney Dis"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1159\/000519587","article-title":"Uremic optic neuropathy: a potentially reversible complication of chronic kidney disease","volume":"12","author":"Raja","year":"2022","journal-title":"Case Rep Nephrol Dial"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"367","DOI":"10.3390\/toxins10090367","article-title":"Impacts of indoxyl Sulfate and p-cresol Sulfate on chronic kidney disease and mitigating effects of AST-120","volume":"10","author":"Liu","year":"2018","journal-title":"Toxins (Basel)"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"114984","DOI":"10.1016\/j.bcp.2022.114984","article-title":"Uremic toxins activate CREB\/ATF1 in endothelial cells related to chronic kidney disease","volume":"198","author":"Stafim da Cunha","year":"2022","journal-title":"Biochem Pharmacol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"901","DOI":"10.3390\/biom13060901","article-title":"The role of retinal pigment epithelial cells in age-related macular degeneration: phagocytosis and autophagy","volume":"13","author":"Si","year":"2023","journal-title":"Biomolecules"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1391999","DOI":"10.3389\/fgene.2024.1391999","article-title":"Systemic inflammatory regulators and age-related macular degeneration: a bidirectional mendelian randomization study","volume":"15","author":"Liu","year":"2024","journal-title":"Front Genet"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"185","DOI":"10.51329\/mehdiophthal1437","article-title":"Hypo-angiogenesis: a possible pathological factor in the development of dry age-related macular degeneration and a novel therapeutic target","volume":"10","author":"Venkatesh","year":"2021","journal-title":"Med Hypothesis Discov Innov Ophthalmol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1159\/000493924","article-title":"Age-related macular degeneration in chronic kidney disease: a meta-analysis of observational studies","volume":"48","author":"Chen","year":"2018","journal-title":"Am J Nephrol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.ajo.2020.01.002","article-title":"Visual impairment and major eye diseases in chronic kidney disease: the National Health and nutrition examination survey, 2005-2008","volume":"213","author":"Zhu","year":"2020","journal-title":"Am J Ophthalmol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1038\/s41598-022-26964-8","article-title":"Increased end-stage renal disease risk in age-related macular degeneration: a nationwide cohort study with 10-year follow-up","volume":"13","author":"Jung","year":"2023","journal-title":"Sci Rep"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1016\/j.ophtha.2020.04.019","article-title":"Prevalence and pattern of geographic atrophy in Asia: the Asian eye epidemiology consortium","volume":"127","author":"Rim","year":"2020","journal-title":"Ophthalmology"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1866","DOI":"10.2215\/cjn.10321110","article-title":"Vision-threatening retinal abnormalities in chronic kidney disease stages 3 to 5","volume":"6","author":"Deva","year":"2011","journal-title":"Clin J Am Soc Nephrol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1080\/09286580902863064","article-title":"Associations between chronic kidney disease and age-related macular degeneration","volume":"16","author":"Nitsch","year":"2009","journal-title":"Ophthalmic Epidemiol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1016\/j.ajo.2006.05.028","article-title":"Retinal vascular abnormalities and prevalence of age-related macular degeneration in adult Chinese: the Beijing eye study","volume":"142","author":"Xu","year":"2006","journal-title":"Am J Ophthalmol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.1016\/j.ophtha.2010.12.030","article-title":"Prevalence of age-related macular degeneration in a rural Chinese population: the Handan eye study","volume":"118","author":"Yang","year":"2011","journal-title":"Ophthalmology"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1097\/IAE.0b013e3181f57ff2","article-title":"Prevalence of age-related macular degeneration in rural Central India: the Central India eye and medical study","volume":"31","author":"Nangia","year":"2011","journal-title":"Retina"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1756","DOI":"10.1016\/j.ophtha.2014.03.022","article-title":"Age-related macular degeneration: prevalence and risk factors from Korean National Health and nutrition examination survey, 2008 through 2011","volume":"121","author":"Park","year":"2014","journal-title":"Ophthalmology"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1080\/09286586.2017.1384504","article-title":"Ural eye and medical study: description of study design and methodology","volume":"25","author":"Bikbov","year":"2018","journal-title":"Ophthalmic Epidemiol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"968","DOI":"10.4103\/IJO.IJO_2558_23","article-title":"Association of eGFR with stages of diabetic retinopathy and age-related macular degeneration in Indian population","volume":"72","author":"Neelamegam","year":"2024","journal-title":"Indian J Ophthalmol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1186\/1471-2369-12-62","article-title":"Ocular fundus pathology and chronic kidney disease in a Chinese population","volume":"12","author":"Gao","year":"2011","journal-title":"BMC Nephrol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"3159","DOI":"10.1093\/ndt\/gfr022","article-title":"Kidney function, albuminuria and age-related macular degeneration in NHANES III","volume":"26","author":"Weiner","year":"2011","journal-title":"Nephrol Dial Transplant"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"6405","DOI":"10.1097\/MD.0000000000006405","article-title":"Association between macular degeneration and mild to moderate chronic kidney disease: a nationwide population-based study","volume":"96","author":"Chen","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1530\/EC-23-0005","article-title":"SGLT2 inhibitors for patients with type 2 diabetes and CKD: a narrative review","volume":"12","author":"Thomas","year":"2023","journal-title":"Endocr Connect"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.semnephrol.2014.02.005","article-title":"The peptidic middle molecules: is molecular weight doing the trick?","volume":"34","author":"Chmielewski","year":"2014","journal-title":"Semin Nephrol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1443","DOI":"10.1126\/scitranslmed.aaf1443","article-title":"Targeting factor D of the alternative complement pathway reduces geographic atrophy progression secondary to age-related macular degeneration","volume":"9","author":"Yaspan","year":"2017","journal-title":"Sci Transl Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1434","DOI":"10.1016\/S0140-6736(23)01520-9","article-title":"Pegcetacoplan for the treatment of geographic atrophy secondary to age-related macular degeneration (OAKS and DERBY): two multicentre, randomised, double-masked, sham-controlled, phase 3 trials","volume":"402","author":"Heier","year":"2023","journal-title":"Lancet"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1681\/asn.2018060609","article-title":"Indoxyl Sulfate and p-cresyl Sulfate promote vascular calcification and associate with glucose intolerance","volume":"30","author":"Opdebeeck","year":"2019","journal-title":"J Am Soc Nephrol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1002\/rth2.12158","article-title":"Circulating endothelial cells as biomarker for cardiovascular diseases","volume":"3","author":"Farinacci","year":"2019","journal-title":"Res Pract Thromb Haemost"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1167\/iovs.10-5756","article-title":"Different populations of circulating endothelial cells in patients with age-related macular degeneration: a novel insight into pathogenesis","volume":"52","author":"Machali\u0144ska","year":"2011","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"3363","DOI":"10.3390\/ijms23063363","article-title":"Pro-calcific environment impairs ischaemia-driven angiogenesis","volume":"23","author":"Mulangala","year":"2022","journal-title":"Int J Mol Sci"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1186\/s12967-024-05654-1","article-title":"Indoxyl sulfate induces retinal microvascular injury via COX-2\/PGE(2) activation in diabetic retinopathy","volume":"22","author":"Zhou","year":"2024","journal-title":"J Transl Med"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"2431651","DOI":"10.1080\/19490976.2024.243165","article-title":"Cerebrovascular damage caused by the gut microbe\/host co-metabolite p-cresol sulfate is prevented by blockade of the EGF receptor","volume":"16","author":"Shah","year":"2024","journal-title":"Gut Microbes"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"2743","DOI":"10.1161\/01.CIR.94.11.2743","article-title":"Hyperhomocysteinemia confers an independent increased risk of atherosclerosis in end-stage renal disease and is closely linked to plasma folate and pyridoxine concentrations","volume":"94","author":"Robinson","year":"1996","journal-title":"Circulation"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/0021-9150(96)05865-0","article-title":"Hyperhomocysteinemia, hyperfibrinogenemia, and lipoprotein (a) excess in maintenance dialysis patients: a matched case-control study","volume":"125","author":"Bostom","year":"1996","journal-title":"Atherosclerosis"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1093\/oxfordjournals.aje.a117648","article-title":"Age-related macular degeneration is associated with atherosclerosis. The Rotterdam study","volume":"142","author":"Vingerling","year":"1995","journal-title":"Am J Epidemiol"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e08973","DOI":"10.1016\/j.heliyon.2022.e08973","article-title":"A histological study of atherosclerotic characteristics in age-related macular degeneration","volume":"8","author":"Wang","year":"2022","journal-title":"Heliyon"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1635766\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T06:31:30Z","timestamp":1764225090000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1635766\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,27]]},"references-count":43,"alternative-id":["10.3389\/fmed.2025.1635766"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1635766","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,27]]},"article-number":"1635766"}}