Ophthalmic Outcomes Across CKD Stages in Systemic Lupus Erythematosus

Author(s): Marina Z. Gad El Sayed, Natasha Klein, Michael Fam, Shreyas Nayakam, Michael Zakhary, Maria Zakhary, Hasson Abdel-Jaber, Rose Bishay, Ibrahim Abboud, Peter Zaki

Purpose: Systemic lupus erythematosus (SLE) carries renal and ocular morbidity. Chronic kidney disease (CKD) may worsen inflammatory and microvascular injury. This study evaluated whether CKD stage is associated with increased ophthalmic complications in SLE. Methods: Adults with SLE in the TriNetX Research Network were stratified by CKD stage (1-5 and ESRD) and propensity-score matched 1:1 to SLE patients without CKD on age, sex, race, hypertension, diabetes mellitus, and other baseline variables. Patients with pre-existing ophthalmic diagnoses were excluded. Incident episcleritis, scleritis, cataract, hypertensive retinopathy, low vision, and blindness were assessed using risk ratios (RR) with 95% confidence intervals. Direct measures of lupus disease activity were not available in the database. Results: Matched cohorts ranged from 5,500 to 28,000 patients. Inflammatory complications were elevated in early CKD: episcleritis (RR 1.54-1.94, stages 1-3) and scleritis (RR 1.43-2.08, stages 1-4). Cataract risk was increased across stages, highest in stage 1 (RR 1.75) and modestly elevated thereafter (RR 1.11-1.29). Hypertensive retinopathy demonstrated a clear severity gradient, rising from stage 1 (RR 1.56) to ESRD (RR 2.73). Vision-threatening outcomes also increased with CKD severity, with blindness peaking in ESRD (RR 2.28) and low vision elevated across all stages (RR 1.22-1.56). Conclusions: Advancing CKD severity in SLE is associated with progressively higher inflammatory, vascular, and vision-threatening ophthalmic complications. These findings support CKD-stage-guided ophthalmic surveillance to reduce preventable vision loss.