Could the type of treatment for chronic kidney disease
               affect the auditory system?

Lopez, Priscila Suman; Silva, Daniela Polo Camargo da; Martin, Luis Cuadrado; Montovani, Jair Cortez

doi:10.5935/1808-8694.20140012

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Brazilian Journal of Otorhinolaryngology

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Original articles • Braz J Otorhinolaryngol. 80 (1) • Jan-Feb 2014 • https://doi.org/10.5935/1808-8694.20140012 copy

Could the type of treatment for chronic kidney disease affect the auditory system?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction:

Chronic kidney disease (CKD) is defined as the presence of renal injury that leads to the slow and progressive loss of kidney function.

Aim:

To compare audiological tests between patients with CKD receiving different types of treatment.

Material and method:

This was a clinical and experimental study. Groups were divided according to treatment: hemodialysis (n = 35), peritoneal dialysis (n = 15), and conservative (n = 51), and were compared to 27 healthy controls. Patients older than 60 years; those with congenital hearing loss, genetic syndromes, and middle-ear infections; and those who had been submitted to a kidney transplant were excluded. Audiologic evaluation included pure-tone audiometry, transient evoked otoacoustic emissions, and auditory brainstem response (ABR). The variables considered were gender, age, diagnosis of arterial hypertension, time since the diagnosis of diabetes and hypertension, CKD stage, duration of CKD, and duration of treatment.

Results:

The variables age, presence of arterial hypertension, and time of CKD were statistically significant and controlled. The auditory thresholds measured by pure-tone threshold audiometry were worse for the conservative treatment group, and the III-V interval of the ABR of the conservative treatment group was significantly greater than that of the hemodialysis groups.

Conclusion:

The conservative treatment group presented worse audiological tests, regardless of hypertension and diabetes, reinforcing that patients need to undergo a complete hearing assessment for better understanding of the disease and its effects on the auditory system.

Hypertension; Diabetes mellitus ; Hearing loss; Renal insufficiency chronic; Electrophysiology

		Groups
		Control	Conservative	Peritoneal dialysis	Hemodialysis	p-value
Male gender		44.1	58.8	40.0	57.1	0.432^a a Chi-squared test
White ethnicity		0.0	7.8	13.3	14.3	0.217^a a Chi-squared test
Arterial hypertension		0.0^a a Chi-squared test	88.0^b b Kruskal-Wallis' test	66.7^b b Kruskal-Wallis' test	91.4^b b Kruskal-Wallis' test	< 0.001^a a Chi-squared test
Diabetes mellitus		0.0	28.0	20.0	37.1	0.006^a a Chi-squared test
CKD stage
	1	0.0	8.2	0.0	0.0
	2	0.0	2.0	0.0	0.0
	3	0.0	24.5	0.0	0.0
	4	0.0	38.8	0.0	0.0
	5	0.0	26.5	100.0	100.0
Age (years)		31 (20-58)^a a Values were expressed as median (range)	51(7-60)^b b Corrected for age and hypertension	47 (22-57)^a a Chi-squared test ^b b Kruskal-Wallis' test	53 (17-60)^b b Kruskal-Wallis' test	< 0.001^b b Kruskal-Wallis' test
Duration of hypertension		-	8 (0.4-3.2)	5 (1.4-26.3)	11.1 (0.6-3.2)	0.202^b b Kruskal-Wallis' test
Duration of diabetes		-	17.0 (0.6-3.1)	22.6 (18.8-24.9)	16.0 (4.2-25.0)	0.207^b b Kruskal-Wallis' test
Duration of CKD		-	2.4 (0.3-16.9)^a a Chi-squared test	4.2 (1.4-25.3)^a a Chi-squared test ^b b Kruskal-Wallis' test	6.9 (0.6-21.8)^b b Kruskal-Wallis' test	0.001^b b Kruskal-Wallis' test
Treatment durationof CKD		-	2.5 (0.3-16.9)	2.3 (0.2-5.8)	2.5 (0.1-21.8)	0.484^b b Kruskal-Wallis' test

Groups
Ear	Frequency	Control	Conservative	Peritoneal dialysis	Hemodialysis
Right	250 Hz	5 (0-15)^a a Values were expressed as median (range).	10 (5-80)^b b Corrected for age and hypertension.	15 (0-40)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.	15 (0-110)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.
	500 Hz	5 (0-15)^a a Values were expressed as median (range).	10 (0-80)^b b Corrected for age and hypertension.	15 (0-45)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.	10 (0-110)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.
	1 kHz	5 (0-15)^a a Values were expressed as median (range).	10 (0-80)^b b Corrected for age and hypertension.	10 (0-40)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.	5 (0-120)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.
	2 kHz	5 (0-10)^a a Values were expressed as median (range).	10 (0-85)^b b Corrected for age and hypertension.	10 (0-35)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.	10 (0-120)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.
	3 kHz	5 (0-15)^a a Values were expressed as median (range).	15 (0-85)^b b Corrected for age and hypertension.	10 (0-35)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.	15 (0-120)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.
	4 kHz	5 (0-15)^a a Values were expressed as median (range).	25 (0-90)^b b Corrected for age and hypertension.	20 (10-45)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.	20 (0-120)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.
	6 kHz	10 (0-25)^a a Values were expressed as median (range).	25 (0-105)^b b Corrected for age and hypertension.	20 (0-55)^a a Values were expressed as median (range).	25 (0-120)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.
	8 kHz	10 (0-15)^a a Values were expressed as median (range).	30 (0-95)^b b Corrected for age and hypertension.	15 (0-65)^a a Values were expressed as median (range).	35 (0-120)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.
Left	250 Hz	5 (0-15)^a a Values were expressed as median (range).	10 (5-100)^b b Corrected for age and hypertension.	15 (0-60)^b b Corrected for age and hypertension.	10 (0-110)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.
	500 Hz	5 (0-15)^a a Values were expressed as median (range).	15 (0-120)^b b Corrected for age and hypertension.	10 (0-60)^b b Corrected for age and hypertension.	10 (0-105)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.
	1 kHz	5 (0-10)^a a Values were expressed as median (range).	10 (0-120)^b b Corrected for age and hypertension.	10 (0-65)^b b Corrected for age and hypertension.	10 (0-110)^b b Corrected for age and hypertension.
	2 kHz	5 (0-10)^a a Values were expressed as median (range).	10 (0-120)^b b Corrected for age and hypertension.	10 (0-50)^b b Corrected for age and hypertension.	10 (0-110)^b b Corrected for age and hypertension.
	3 kHz	5 (0-10)^a a Values were expressed as median (range).	15 (0-120)^b b Corrected for age and hypertension.	15 (0-45)^b b Corrected for age and hypertension.	15 (0-115)^b b Corrected for age and hypertension.
	4 kHz	10 (0-15)^a a Values were expressed as median (range).	20 (0-115)^b b Corrected for age and hypertension.	10 (0-50)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.	20 (0-120)^b b Corrected for age and hypertension.
	6 kHz	10 (0-15)^a a Values were expressed as median (range).	30 (0-100)^b b Corrected for age and hypertension.	35 (5-90)^b b Corrected for age and hypertension.	25 (0-120)^b b Corrected for age and hypertension.
	8 kHz	10 (0-20)^a a Values were expressed as median (range).	25 (0-120)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.	25 (5-90)^b b Corrected for age and hypertension.	30 (0-120)^a a Values were expressed as median (range). ^b b Corrected for age and hypertension.

	ABR	Groups	Grupos
Ear		Control	Conservative	Peritoneal dialysis	Hemodialysis
Right	I	1.37 (1.17-1.60)^a a Values were expressed as median (range)	1.40 (1.17-1.90)^a a Values were expressed as median (range)	1.40 (1.20-1.57)^a a Values were expressed as median (range)	1.47 (0.93-1.83)^a a Values were expressed as median (range)
	III	3.47 (3.23-3.90)^a a Values were expressed as median (range)	3.60 (3.27-4.07)^a a Values were expressed as median (range)	3.67 (3.37-3.90)^a a Values were expressed as median (range)	3.62 (3.20-4.53)^a a Values were expressed as median (range)
	V	5.50 (5.27-5.93)^a a Values were expressed as median (range)	5.77 (5.20-6.60)^a a Values were expressed as median (range)	5.77 (5.27-6.23)^a a Values were expressed as median (range)	5.70 (5.13-6.60)^a a Values were expressed as median (range)
	I-III	2.10 (1.83-2.43)^a a Values were expressed as median (range)	2.17 (1.77-2.73)^a a Values were expressed as median (range)	2.23 (2.00-2.43)^a a Values were expressed as median (range)	2.20 (1.73-2.70)^a a Values were expressed as median (range)
	III-V	2.07 (1.50-2.40)^a a Values were expressed as median (range) ^b b Corrected for age and hypertension	2.13 (1.73-2.80)^a a Values were expressed as median (range)	2.10 (1.60-2.73)^a a Values were expressed as median (range) ^b b Corrected for age and hypertension	2.07 (1.87-2.53)^b b Corrected for age and hypertension
	I-V	4.20 (3.77-4.67)^a a Values were expressed as median (range)	4.30 (3.80-5.43)^a a Values were expressed as median (range)	4.33 (3.97-4.97)^a a Values were expressed as median (range)	4.25 (3.77-4.77)^a a Values were expressed as median (range)
Left	I	1.37 (1.20-1.53)^a a Values were expressed as median (range)	1.37 (1.17-1.87)^a a Values were expressed as median (range)	1.40 (1.17-1.57)^a a Values were expressed as median (range)	1.43 (1.17-2.00)^a a Values were expressed as median (range)
	III	3.49 (3.20-3.70)^a a Values were expressed as median (range)	3.57 (3.37-4.07)^a a Values were expressed as median (range)	3.62 (3.43-3.97)^a a Values were expressed as median (range)	3.67 (3.27-4.43)^a a Values were expressed as median (range)
	V	5.47 (5.27-5.90)^a a Values were expressed as median (range)	5.73 (5.30-7.43)^a a Values were expressed as median (range)	5.69 (5.47-6.23)^a a Values were expressed as median (range)	5.80 (5.27-6.43)^a a Values were expressed as median (range)
	I-III	2.12 (1.77-2.47)^a a Values were expressed as median (range)	2.20 (1.77-2.80)^a a Values were expressed as median (range)	2.25 (2.03-2.63)^a a Values were expressed as median (range)	2.27 (2.00-2.90)^a a Values were expressed as median (range)
	III-V	2.07 (1.73-2.37)^a a Values were expressed as median (range) ^b b Corrected for age and hypertension	2.10 (1.83-3.67)^a a Values were expressed as median (range)	2.09 (1.67-2.30)^a a Values were expressed as median (range) ^b b Corrected for age and hypertension	2.09 (1.77-2.27)^b b Corrected for age and hypertension
	I-V	4.12 (3.80-4.67)^a a Values were expressed as median (range)	4.33 (3.87-5.87)^a a Values were expressed as median (range)	4.35 (4.03-4.90)^a a Values were expressed as median (range)	4.33 (3.90-5.00)^a a Values were expressed as median (range)

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] Corresponding author. E-mail: priscilasuman@gmail.com (P.S. Lopez).