Is Blurry Vision a Symptom of CKD?
Blurry vision is not a direct symptom of CKD itself, but rather a manifestation of the underlying conditions that cause CKD—primarily diabetes and hypertension—which damage both the kidneys and eyes through shared microvascular pathology. 1
Understanding the Eye-Kidney Connection
The relationship between vision problems and CKD is indirect but clinically significant:
- Diabetic retinopathy and hypertensive retinopathy are the primary causes of vision impairment in CKD patients, not the kidney disease itself 1, 2
- The typical presentation of diabetic kidney disease includes long-standing diabetes duration, retinopathy, and albuminuria, indicating that eye and kidney damage progress in parallel 1
- Eyes and kidneys share numerous structural, developmental, physiologic, and pathogenic pathways, meaning many kidney and eye diseases are interlinked through common vascular and metabolic mechanisms 2
Clinical Evidence and Prevalence
The burden of eye disease in CKD patients is substantial:
- 45% of CKD patients have eye pathologies requiring ophthalmologic follow-up, with 25% showing retinopathy (diabetic and/or hypertensive) 3
- Patients with eGFR <30 mL/min/1.73 m² have a three times higher risk for retinopathy compared to those with better kidney function 3
- CKD increases the risk of incident visual impairment (OR = 1.47) and moderate/worse diabetic retinopathy (OR = 2.62) in Asian populations 4
- The incidence of visual impairment increases with CKD severity: 3.3% in stages G1-G2, 13.5% in stage G3a, and 16.3% in stages G3b-G5 4
Guideline-Based Screening Recommendations
If diabetic retinopathy is present at any level, dilated retinal examinations should be repeated at least annually by an ophthalmologist or optometrist, with more frequent examinations if retinopathy is progressing or sight-threatening. 1
For patients with type 2 diabetes and CKD:
- Comprehensive eye examination should be performed at diagnosis of type 2 diabetes, as CKD may already be present 1
- Patients without retinopathy should undergo follow-up every 1-2 years 1
- Optimize glycemic control, blood pressure, and lipid management to reduce risk or slow progression of diabetic retinopathy 1
Critical Clinical Pitfalls to Avoid
- Do not assume blurry vision is "just from CKD"—it requires ophthalmologic evaluation to identify treatable causes like diabetic retinopathy, hypertensive retinopathy, cataracts, or age-related macular degeneration 2, 3
- Do not delay ophthalmology referral in CKD patients with any visual symptoms, as 3% have serious eye conditions requiring urgent treatment 3
- Be aware that patients undergoing dialysis may develop acute eye problems such as acute glaucoma, particularly those with a history of glaucoma or recent ocular surgery 2
- Retinopathy is only moderately sensitive and specific for CKD in type 2 diabetes—its absence does not exclude kidney disease 1
Specific Eye Conditions Associated with CKD
Beyond retinopathy, CKD patients have increased risk of: