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Risk of corneal ulcer in patients with end-stage renal disease: a retrospective large-scale cohort study
  1. Ren-Long Jan1,2,
  2. Ming-Cheng Tai3,
  3. Shih-Feng Weng4,
  4. Chun Chang5,
  5. Jhi-Joung Wang6,7,
  6. Yuh-Shin Chang2,8
  1. 1 Department of Pediatrics, Chi Mei Medical Center, Liouying, Tainan, Taiwan
  2. 2 Graduate Institute of Medical Science, College of Health Science, Chang Jung Christian University, Tainan, Taiwan
  3. 3 Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
  4. 4 Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
  5. 5 Department of Education, University of Taipei, Taipei, Taiwan
  6. 6 Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
  7. 7 Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
  8. 8 Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan
  1. Correspondence to Dr Yuh-Shin Chang, Department of Ophthalmology, Chi Mei Medical Center, 901 Zhonghua Rd, Yongkang District, Tainan 71004, Taiwan; yuhshinchang{at}


Background/Aims To investigate the risk of corneal ulcer in patients with end-stage renal disease (ESRD).

Methods This retrospective, nationwide, matched cohort study included 92 967 patients with ESRD recruited between 2000 and 2009 from the Taiwan National Health Insurance Research Database. The same number of age-matched and sex-matched patients without ESRD were selected from the Taiwan Longitudinal Health Insurance Database, 2000 as the control group. Data for each patient were collected from the index date until December 2011. Corneal ulcer incidence rate and risk were compared between the groups. A Cox proportional hazards regression was used to calculate the HR for a corneal ulcer after adjustment for potential confounders. The cumulative corneal ulcer incidence rate was calculated using Kaplan-Meier analysis.

Results In total, 660 patients with ESRD and 591 controls showed a corneal ulcer during follow-up; thus, the corneal ulcer incidence rate in patients with ESRD was 1.54 times (95% CI 1.38–1.72) that in the control patients. After adjustment for potential confounders, including diabetes mellitus and HIV disease, patients with ESRD were 1.17 times (95% CI 1.03 to 1.33) more likely to develop a corneal ulcer in the cohort for the total sample. Among patients with diabetes mellitus, the corneal ulcer incidence rate was significantly higher in the ESRD group, and diabetes mellitus significantly increased corneal ulcer risk even after adjustment for other confounders in the cohort.

Conclusion ESRD increases the risk of a corneal ulcer, particularly in patients with ESRD with diabetes mellitus. Regular ocular examinations are suggested for patients with ESRD.

  • corneal ulcer
  • end-stage renal disease
  • Taiwan Longitudinal Health Insurance Database

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  • R-LJ and M-CT contributed equally.

  • Handling editor James Chodosh.

  • Contributors All authors conceived the study. RLJ, MCT, SFW, CC and YSC conducted the study. RLJ, MCT, SFW and YSC analysed the results. JJW provided materials. RLJ, MCT and YSC wrote the article. All authors reviewed the manuscript.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Chi Mei Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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