This systematic review and meta-analysis examined the association between renal impairment (CKD, reduced eGFR, albuminuria/proteinuria, dialysis) and AMD in adults, pooling 19 observational studies and 2 Mendelian randomization (MR) analyses identified from inception to August 2025.
CKD was associated with higher odds of AMD (OR 1.27, 95% CI 1.07–1.50; I² = 95.1%); odds were higher with eGFR <60 mL/min/1.73 m² (OR 1.40), dialysis ≥90 days (OR 1.74), and each SD decrease in eGFR (OR 1.30). Non-exudative AMD showed the most consistent signal (OR 1.46). Two MR studies supported a causal link (pooled OR 1.65, 95% CI 1.54–1.76).
- Very high heterogeneity (I² = 95.1%) means the pooled OR reflects a central tendency across a diverse evidence base, not a precise individual risk estimate. - Most subgroup certainty was rated low or very low due to heterogeneity and imprecision; formal causal inference remains premature. - Observational designs dominate; variation in CKD and AMD definitions across studies limits direct comparability.
Consider routine ocular surveillance for AMD in patients with CKD, especially those with eGFR <60 mL/min/1.73 m² or on long-term dialysis. Shared vascular risk reduction strategies across nephrology and ophthalmology are supported by this evidence, even though causality is not yet confirmed.
