{"paper_id":"06ae246b-96bf-4a29-a88f-927aefcf96e6","body_text":"The Association Between Chronic Kidney Disease and Sensorineural Hearing Loss in Patients at the Colombo North Teaching Hospital Nephrology Clinic, Aged 20- 70 Years | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Association Between Chronic Kidney Disease and Sensorineural Hearing Loss in Patients at the Colombo North Teaching Hospital Nephrology Clinic, Aged 20- 70 Years Heshave Logendran, Nilupul Rupasinghe, Maithri Rupasinghe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8915495/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Although numerous studies have investigated the relationship between chronic kidney disease and sensorineural hearing loss, the specific correlation between these conditions remains insufficiently explored. However, sensorineural hearing loss is a recognized complication in patients with chronic kidney disease. Understanding the connection between CKD and SNHL is crucial for developing effective therapeutic interventions within the medical community. This study aimed to determine the prevalence and correlation of SNHL among patients with CKD and identify associated risk factors. Methods: This descriptive, cross-sectional study was conducted among 121 CKD patients aged 20–70 years who were recruited from the Nephrology Clinic at Colombo North Teaching Hospital. Data were gathered via an interviewer-administered questionnaire and audiological assessments (otoscopy and pure tone audiometry). Random sampling and inferential statistical analysis were performed via SPSS software (version 26). CKD staging was determined by the estimated glomerular filtration rate. Results: Among 121 patients, the male-to-female ratio was 1.5:1.0. Bilateral hearing loss was observed in 85.95% of the participants, with most cases ranging from mild to moderately severe. However, the degree of hearing loss varies, and there is no clear progression across advanced stages of CKD. The analysis revealed that the severity of SNHL increased with age, prolonged duration of CKD, the presence of diabetes mellitus, and the use of specific ototoxic medications. In contrast, hypertension was not significantly associated with hearing loss. Conclusion: SNHL is highly prevalent among CKD patients across all stages. This study emphasizes the importance of regular audiological assessments in the management and follow-up of CKD in Sri Lanka. Furthermore, this study represents one of the initial investigations within Sri Lanka to establish the prevalence of SNHL in CKD patients, contributing context-specific insights to inform clinical management and preventive strategies. Chronic kidney disease Sensorineural hearing loss Nephrology Clinic Audiological assessments Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Background Auditory impairment, a common sensory deficit particularly prevalent in the geriatric population ( 2 ), is broadly categorized into sensorineural, conductive, and mixed aetiologies. Sensorineural hearing loss (SNHL), the most frequently encountered type of hearing loss, typically arises from pathology affecting sensory hair cells, synaptic connections, or spiral ganglion neurons (SGNs) within the cochlea ( 7 ). Chronic kidney disease (CKD) constitutes a substantial global health burden and is associated with an increased incidence of SNHL in affected individuals. In the CKD population, factors such as, hypertension, diabetes mellitus, electrolyte imbalances, haemodialysis and pharmacological interventions are implicated in the pathogenesis of sensorineural hearing loss ( 1 ). In addition, the stages of CKD are classified based on, glomerular filtration rate (GFR) category (G1–G5), and albuminuria category (A1–A3). The GFR represents the level of kidney function, whereas albuminuria represents the level of albumin in the urine. Stage 1 indicates kidney damage with a normal or high GFR (≥ 90 mL/min/1.73 m²), whereas stage 2 reflects a mild reduction in the GFR (60–89 mL/min/1.73 m²). Stage 3a denotes a mild to moderate reduction in the GFR (45–59 mL/min/1.73 m²), Stage 3b reflects a moderate to severe reduction in the GFR (30–44 mL/min/1.73 m²), and Stage 4 refers to a severe reduction in the GFR (15–29 mL/min/1.73 m²). Finally, Stage 5 represents kidney failure, defined by a GFR < 15 mL/min/1.73 m². Similarly, A1 indicates a normal to mildly increased level (< 3 mg/mmol), A2 reflects a moderately increased level (3–30 mg/mmol), and A3 indicates a severely increased level (> 30 mg/mmol). Therefore, either GFR decreases or albuminuria increases, increasing the risk of CKD complications ( 19 ). CKD represents a significant public health challenge in Sri Lanka, particularly for middle- and lower-income populations, with hearing loss emerging as a potential and often overlooked comorbidity. Hearing loss can lead to social isolation and communication difficulties among all stages of CKD patients. Notably, routine hearing tests are not standard practice for CKD patients in Sri Lanka and can delay the diagnosis and management of hearing loss in this population. Furthermore, haemodialysis can increase the risk of hearing loss due to exposure to ototoxic medications. Therefore, recognizing these interconnected issues is crucial for developing effective diagnostic and therapeutic approaches for CKD patients in Sri Lanka. Previous studies have not examined the relationship between CKD and SNHL across all stages of CKD. This study, therefore, aimed to assess the prevalence and association of SNHL in patients having CKD. Several studies have explored the association between CKD and SNHL; however, the underlying mechanisms linking these conditions remain unclear ( 8 ) ( 21 ). One recent study ( 23 ) found that the findings do not establish a causal link between hearing loss, tinnitus, and chronic kidney disease, highlighting the need for further, more extensive prospective studies to confirm this association. Moreover, CKD is the fourth leading cause of hospitalization and the sixth leading cause of mortality in Sri Lankan hospitals ( 17 ). Data collected in 2020 identified approximately 164,000 individuals affected by CKD in Sri Lanka ( 22 ). SNHL is the most frequently associated type of hearing loss in patients experiencing CKD ( 5 ). This study aimed to evaluate the association between chronic kidney disease (CKD) and sensorineural hearing loss (SNHL) across all CKD stages among adults aged 20–70 years attending a tertiary nephrology clinic in Sri Lanka. Although international literature suggests a relationship between CKD and SNHL, evidence from Sri Lanka remains limited, particularly across the full spectrum of CKD severity. Addressing this gap is important for generating context-specific data relevant to local clinical practice. By assessing hearing function using standardized audiometric evaluation, this study sought to quantify the prevalence and severity of SNHL in CKD patients and to explore associated risk factors. Understanding this relationship may support earlier identification of at-risk individuals and inform more comprehensive, multidisciplinary management strategies within nephrology care. Furthermore, locally derived evidence may contribute to improving awareness, screening practices, and long-term outcomes among patients with CKD. Methods Design and setting This descriptive, cross-sectional, quantitative study recruited patients via random sampling from the Nephrology Clinic at the Colombo North Teaching Hospital in Sri Lanka. The study was conducted at the Audiology Unit of the Ayati Center for Children with Disabilities at the Faculty of Medicine, Ragama, Sri Lanka. The study aimed for a sample size of 305; however, only 121 patients provided consent. Additionally, the sample size was calculated via OpenEpi Version 3 ( 24 ). This discrepancy, attributed to participant refusal or unavailability, could lead to nonresponse bias if participants who did not respond differ in characteristics from those who did. Inclusion criteria Patients aged between 20 and 70 years. Patients who were diagnosed with chronic kidney disease (CKD) and who attended the Nephrology Clinic at Colombo North Teaching Hospital were recruited. Patients were willing to participate in the study and provided informed written consent. Exclusion criteria Patients younger than 20 years or older than 70 years of age. Patients with acute kidney injury or other renal conditions not classified as CKD. Patients with a history of congenital hearing loss or other known causes of sensorineural hearing loss not related to CKD. Patients with a history of neurodegenerative disorders. Patients who were unwilling or unable to participate or who did not provide informed written consent. Patients with uremic encephalopathy, severe illness, or unresponsive patients. Patients with chronic otitis media, tympanosclerosis, and otosclerosis. Data collection Data collection commenced after approval from the Ethics Review Committee at the Faculty of Medicine, University of Kelaniya, and the Nephrology Clinic at the Colombo North Teaching Hospital. Moreover, all eligible patients who met the inclusion criteria were enrolled, and informed written consent for participation was obtained. The baseline evaluation was subsequently performed via a researcher-administered questionnaire, which included demographic information; details regarding hearing and hearing difficulties; and participants’ histories of kidney disease, as well as pertinent information regarding haemoglobin levels, serum creatinine, serum sodium, serum potassium, serum calcium, serum phosphate, and systolic and diastolic blood pressure from medical laboratory records. The questionnaire used in this study was developed by the research team specifically for this project and is provided as Supplementary File 1 An otoscopic examination was subsequently performed, which lasted approximately two minutes. An audiometric evaluation was subsequently conducted to assess both air- and bone-conduction pathways using pure-tone audiometry. The participants wore specialized headphones, commonly used in audiology, that covered their ears and delivered tones at varying frequencies and intensities. They were instructed to press a button to indicate when they perceived each tone. Audiograms were created from their responses to determine hearing thresholds at frequencies ranging from 250 Hz to 8000 Hz. Each test took approximately 10 to 15 minutes. Furthermore, the prevalence, correlations, and potential risk factors for sensorineural hearing loss among patients at all stages of chronic kidney disease in the specified age groups were assessed using pure-tone audiometry. Data analysis method The quantitative data were analysed via descriptive statistics with IBM SPSS Statistics for Windows, Version 26.0. Descriptive and inferential statistics were applied. Frequencies and percentages were used for discrete variables. Chi-square tests were conducted to assess differences in proportions. Differences were considered significant if the p-value was less than 0.05. Microsoft Word and Excel were used to create graphs and tables to display the findings. Results Gender distribution in patients with CKD (n=121). The Fig. 1 shows the sex distribution of the study population (n = 121) recruited from the Nephrology Clinic at Colombo North Teaching Hospital. The study included 73 men (60.33%) and 48 women (39.67%), with ages ranging from 20 to 70 years. This study provides context for interpreting demographic influences on hearing loss. Moreover, no evaluation was applied, as this is descriptive demographic information. Figure 2 Age-related distribution of sensorineural hearing loss across CKD stages. Figure 2 indicates the distribution of hearing loss across four subgroups (20–30, 31–40, 41–50, 51–60, and 61–70 years). The prevalence of SNHL increased with increasing age. Additionally, a chi-square test revealed a significant association between SNHL and CKD stage, with respect to age (p < 0.001). Therefore, this relationship highlights aging as significant factor in SNHL among CKD patients. The participants were categorized into five groups as shown in the Fig. 3 based on the severity of hearing loss: normal, normal-to-mild, mild-to-moderately-severe, minimal-to-moderately-severe, and mild-to-profound. Among patients with CKD, mild-to-moderately severe hearing loss was the most common degree, whereas normal hearing was more common in the early stages of CKD (stage 1 and stage 2). There was a statistically significant correlation between the degree of SNHL and CKD stage (p < 0.001), suggesting that the severity of renal dysfunction is associated with the degree of hearing loss. Patients were categorized into five subgroups based on CKD duration: less than 1 year, 1–3 years, 3–5 years, 5–7 years, and more than 7 years. The Fig. 4 shows a statistically significant correlation between hearing loss and CKD stage, with respect to CKD duration (p = 0.010). Therefore, prolonged duration of CKD appears to exacerbate CKD and may also contribute to the progression of hearing loss. Figure 5 Prevalence of hypertension across CKD stages. Figure 6 Prevalence of Diabetes Mellitus among CKD stages. Figure 7 displays the occurrence of ototoxic drug use across CKD stages. Usage increased gradually toward stage 5, with frusemide being the most common ototoxic medication reported. In addition, the association between CKD stage and ototoxic drug exposure was significant (p < 0.001). These findings underscore the importance of medication monitoring in preventing SNHL among patients with CKD. Figure 8 illustrates the distribution of tinnitus among CKD stages. Although tinnitus was most reported in stage 5 patients, the association between tinnitus and CKD stage was not statistically significant (p = 0.267). These findings indicate that tinnitus incidence varies across CKD stages and may not be directly correlated with renal disease severity. Table 1 Comparison of risk factors in CKD patients with and without hearing loss. Risk factors CKD patients with hearing loss (n = 104) CKD patients without hearing loss (n = 17) P value Hypertension (%) 91.35 88.24 0.338 Diabetes mellitus (%) 82.69 41.17 0.001 Ototoxic drug exposure (%) 67.31 41.17 0.038 Mean age (years) 59.421 59.452 < 0.001 Median duration of CKD (years) 3.15 2 0.010 The Table 1 compares key risk factors, including diabetes mellitus, hypertension, ototoxic drug exposure, age, and CKD duration, between CKD patients with hearing loss (n = 104) and those without hearing loss (n = 17). Furthermore, diabetes mellitus (p = 0.001), ototoxic drug exposure (p = 0.038), age (p < 0.001), and CKD duration (p = 0.010) were significantly associated with hearing loss, whereas hypertension was not (p = 0.338). These findings emphasize that metabolic and pharmacological factors contribute to SNHL among individuals with CKD. Table 2 Comparison of blood parameters in CKD patients with and without hearing loss. Blood parameters CKD patients with hearing loss (n = 104) CKD patients without hearing loss (n = 17) P value Mean haemoglobin (g/dL) 11.43 11.42 0.904 Median serum creatinine (mg/dL) 182.5 100 0.011 Mean serum calcium (mmol/L) 2.31 2.32 0.533 Mean serum potassium (mmol/L) 4.32 4.35 0.123 Mean serum phosphate (mmol/L) 1.23 1.22 0.963 Mean serum sodium (mmol/L) 137.72 138.05 0.113 The Table 2 compares haemoglobin levels, serum creatinine, serum calcium, serum potassium, serum phosphate and serum sodium between CKD patients with hearing loss (n = 104) and those without hearing loss (n = 17). Moreover, the median serum creatinine level differed significantly between the groups (p = 0.011), whereas the other parameters were not significantly different. Chronic kidney disease (CKD) is worsening, as evidenced by increased blood creatinine levels and a statistically significant correlation with the occurrence of hearing loss. Discussion Research consistently indicates a correlation between chronic kidney disease (CKD) and sensorineural hearing loss (SNHL). Studies have shown that the SNHL incidence in CKD patients ranges from 54% to 90% ( 14 ) ( 18 ), increasing with CKD progression, with stage V patients exhibiting the highest rates ( 14 ). Similarly, the present study also revealed a strong correlation between all stages of CKD and SNHL (p < 0.001), identifying it as the most associated type of hearing loss in CKD patients, with a prevalence of 85.95% across all stages. Moreover, mild-to-moderately severe sloping hearing loss, often bilateral and symmetric, is most frequently encountered in CKD patients, although its severity varies across stages. Mild to moderate hearing loss is predominant, with the severity fluctuating to profound ( 18 ) ( 11 ). However, the correlation between CKD stage and hearing loss severity is not consistently observed. Hearing loss is typically bilateral, mild in degree, and primarily affects high frequencies ( 16 ) ( 6 ). Conversely, ( 13 ) reported that some patients may have had normal hearing, which aligns with the current study's finding that 14% of CKD patients presented with normal hearing. This study focused on identifying potential risk factors for SNHL development in CKD patients, specifically age, CKD duration, comorbidities such as hypertension and diabetes, relevant blood parameters, exposure to ototoxic medications, and tinnitus. Notably, the findings revealed a statistically significant correlation between hearing loss and CKD stage, considering factors such as age (p < 0.001), duration of CKD (p = 0.010), exposure to ototoxic drugs (p < 0.001), diabetes mellitus (p = 0.001) and serum creatinine (p = 0.011). Consistently, aging, CKD duration, diabetes mellitus, exposure to ototoxic drugs, and serum creatinine levels are significantly correlated with SNHL ( 15 ) ( 10 ) ( 4 ) ( 12 ). In contrast, one study reported that SNHL was not associated with CKD duration ( 9 ). Furthermore, there is a notable association between tinnitus and CKD, but not across all CKD stages ( 23 ). Conversely, no significant associations were observed between tinnitus and any stage of CKD (p = 0.267). Similarly, the present study found no substantial association between hypertension and any stage of CKD (p = 0.338), consistent with studies reporting no correlation between sensorineural hearing loss and hypertension in CKD patients ( 3 ). However, contrasting findings from other studies suggest an elevated risk ( 20 ), potentially due to variations in study demographics, sample sizes, or blood pressure management in Sri Lankan clinical settings. In summary, aging, diabetes mellitus, exposure to ototoxic drugs, elevated serum creatinine levels, and prolonged duration of chronic kidney disease were identified as significant risk factors for hearing loss in this CKD population. Sensorineural hearing loss is also globally prevalent among patients with chronic kidney disease. However, the lack of regular audiological assessments in nephrology clinics and the restricted access to audiology services in Sri Lanka represent significant deficiencies in patient care. Therefore, implementing portable screening audiometry for CKD patients can mitigate the psychosocial effects of untreated hearing loss and improve their quality of life. Strengths of the study Patients across all stages of CKD and age groups (20–70 years) were included. Factors contributing to hearing loss were investigated within the CKD population. The study benefits from recruiting people directly from a hospital setting, which preserves the sample's clinical relevance and representativeness despite a lower participation rate. Precise selection criteria were implemented, and comprehensive matching was performed to reduce potential selection bias. Despite a reduced sample size due to declining patient involvement, which may have affected the statistical power and generalizability, the available participants were sufficient to provide reliable insights relevant to the objectives of the study. The inclusion of both hearing and tinnitus status in the analysis of the CKD population makes this study more comprehensive and provides a broader perspective than analyses focusing solely on hearing status. Limitations The cross-sectional observational design prevented the establishment of a causal relationship. The number of patients enrolled was insufficient to ensure generalizability to the whole population. This study did not examine potential risk factors such as hemodialysis, serum urea level, and electrolyte imbalances. In the present study, pure tone audiometry was employed; the use of more sensitive methods, such as otoacoustic emission and auditory brainstem evoked response, could have increased the sensitivity of the study. Study implications The findings of this study underscore the importance of early diagnosis through regular check-ups, along with timely follow-up and appropriate management, to reduce the occurrence of SNHL in CKD patients. The study recommends the implementation of systematic audiological screening for all stages of chronic kidney disease (CKD) patients, especially those with comorbidities such as diabetes, exposure to ototoxic medications, extended CKD duration, advanced age, and those receiving hemodialysis. Recommendations Although some patients with chronic kidney disease (CKD) report tinnitus, the precise relationship between CKD progression and tinnitus remains unclear. Well-designed longitudinal and prospective studies are warranted to further explore and clarify this potential association. The present study did not demonstrate significant associations between hearing loss and serum urea levels, electrolyte disturbances, or hemodialysis status. Future research with larger sample sizes and longitudinal designs is recommended to better elucidate the potential contributions of these factors to audiological complications in CKD patients. The possible impact of hemodialysis on hearing function remains inconclusive. Long-term prospective studies are needed to determine whether hemodialysis exerts protective, neutral, or detrimental effects on auditory function in individuals with CKD. Judicious prescription and careful monitoring of ototoxic medications are strongly recommended in CKD patients, particularly in advanced stages of disease, to minimize preventable auditory damage. Routine audiological screening should be considered as part of comprehensive CKD management, especially for patients with advanced age, prolonged disease duration, diabetes mellitus, elevated serum creatinine levels, or exposure to ototoxic drugs. Early detection and timely intervention may significantly reduce the psychosocial burden of untreated sensorineural hearing loss (SNHL) and improve overall quality of life. Further translational and mechanistic research exploring the shared physiopathological pathways between renal and cochlear dysfunction may contribute to improved therapeutic strategies and integrated models of care, ultimately enhancing patient-centered outcomes in CKD management. Conclusion Sensorineural hearing loss is a common complication observed at the Nephrology Clinic of Colombo North Teaching Hospital in Sri Lanka, with a high prevalence of mild-to-moderately severe bilateral hearing impairment. Evidence indicates a correlation between the progression of chronic kidney disease and the increasing severity of SNHL, suggesting that as CKD progresses, the degree of SNHL also increases, which intensifies with age, duration of CKD, diabetes mellitus, serum creatinine level, and exposure to ototoxic drugs. This study could not establish that hypertension is a risk factor for hearing loss in CKD. The SNHL observed in CKD patients is often irreversible and challenging to manage, significantly reducing their quality of life. Therefore, early detection and improved patient outcomes through periodic hearing screening, prompt follow-up care, and appropriate rehabilitation interventions are crucial for mitigating the occurrence and progression of SNHL in this population. Integrating hearing care into nephrology services in Sri Lanka, where chronic kidney disease is prevalent and healthcare resources are limited, offers a pragmatic solution for enhancing accessibility to comprehensive care. Abbreviations CKD chronic kidney disease SNHL sensorineural hearing loss SGNs Spiral ganglion neurons Declarations Ethics approval and consent to participate Ethical approval for the study was obtained from the Ethics Review Committee of the Faculty of Medicine, University of Kelaniya, Sri Lanka (P/72/04/2024). The study was conducted in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Participants were recruited only after providing informed consent and could withdraw at any time without negative consequences. Informed consent was obtained through telephone; subsequently, the written informed consent form and the participant information sheet were provided prior to the data collection. Consent for publication Not Applicable Availability of data and materials The data that support the findings (individual interview transcripts in English) are not openly available. All the data were treated with strict confidentiality and securely stored in a locked cabinet and on a password-protected computer that was accessible only to the researcher and the supervising faculty member. Competing interests The author declares no competing interests. Funding The researcher personally funded transportation costs for participating patients, considering the Ayati Centre's proximity to the Nephrology Clinic at Colombo North Teaching Hospital. Authors’ contributions HL prepared the proposal, conducted the data collection and did the data analyses. MR, NR, HL prepared the main manuscript text. All authors contributed to the discussion of the findings, writing and reviewing the manuscript. Acknowledgements The author would like to express gratitude to the research supervisor Dr. Maithri Rupasinghe, Senior Lecturer (Grade II) and Head of the Department of Family Medicine, Faculty of Medicine, University of Kelaniya, as well as Dr. Liyanage Ranaweera, Director of Colombo North Teaching Hospital, Ragama, and Dr. Nalaka Herath, Consultant Nephrologist, Nephrology Clinic, Colombo North Teaching Hospital, for granting permission to recruit patients from the hospital. Authors’ information 1 Department of Disabilities Study, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka 2 Department of Family Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka References Agrawal M, Singh CV. Sensorineural Hearing Loss in Patients With Chronic Kidney Disease: A Comprehensive Review. Cureus. 2023;15(11). https://doi.org/10.7759/cureus.48244 . Andrusjak W, Barbosa A, Mountain G. 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Chronic kidney disease in Sri Lanka: Health systems challenges of patients on hemodialysis. Public Health Challenges. 2024b;3(1). https://doi.org/10.1002/puh2.155 . Zou Y, Tang X, Rao K, Zhong Y, Chen X, Liang Y, Pi Y. Association between hearing loss, tinnitus, and chronic kidney disease: the NHANES 2015–2018. Front Med. 2024;11. https://doi.org/10.3389/fmed.2024.1426609 . https://www.openepi.com/SampleSize/SSPropor.htm Additional Declarations No competing interests reported. Supplementary Files QuestionaireandResultssheet.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8915495\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":603032455,\"identity\":\"79afb0b0-0729-4187-9e0e-70bcd3719a48\",\"order_by\":0,\"name\":\"Heshave Logendran\",\"email\":\"data:image/png;base64,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\",\"orcid\":\"\",\"institution\":\"University of Kelaniya\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Heshave\",\"middleName\":\"\",\"lastName\":\"Logendran\",\"suffix\":\"\"},{\"id\":603032457,\"identity\":\"0ff3397a-6d44-4ac3-b4f3-74320396052e\",\"order_by\":1,\"name\":\"Nilupul Rupasinghe\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Kelaniya\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Nilupul\",\"middleName\":\"\",\"lastName\":\"Rupasinghe\",\"suffix\":\"\"},{\"id\":603032460,\"identity\":\"b93a3901-a01b-494b-bc8f-b4d4446f6dfc\",\"order_by\":2,\"name\":\"Maithri Rupasinghe\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Kelaniya\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Maithri\",\"middleName\":\"\",\"lastName\":\"Rupasinghe\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-02-19 08:38:14\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8915495/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8915495/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":104779845,\"identity\":\"b00590c1-18a1-4443-a5dd-d67a755868f8\",\"added_by\":\"auto\",\"created_at\":\"2026-03-17 07:46:45\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":92799,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eSee image above for figure legend\\u0026nbsp;\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8915495/v1/4c47b8dfdeaabeaa0696a09a.png\"},{\"id\":104406386,\"identity\":\"f5db9e14-258c-4c77-9cb5-e8147f817f41\",\"added_by\":\"auto\",\"created_at\":\"2026-03-11 12:25:36\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":85325,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cem\\u003eAge-related distribution of sensorineural hearing loss across CKD stages\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8915495/v1/d7aeff66d6b1a0548e97c1b3.png\"},{\"id\":104406034,\"identity\":\"f8c475f7-cf04-462d-b1fa-779c640f7c88\",\"added_by\":\"auto\",\"created_at\":\"2026-03-11 12:24:38\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":237815,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cem\\u003eDegree of sensorineural hearing loss among CKD patients\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8915495/v1/f331103bf6f236b9cf486efa.png\"},{\"id\":104406224,\"identity\":\"3611c346-6384-4a1d-ae44-d0e22b31f442\",\"added_by\":\"auto\",\"created_at\":\"2026-03-11 12:25:05\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":87386,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cem\\u003eDistribution of sensorineural hearing loss according to duration of CKD.\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8915495/v1/00731589a98772ea2585844d.png\"},{\"id\":104406265,\"identity\":\"f037545f-d095-4535-b061-9075f95ea1a3\",\"added_by\":\"auto\",\"created_at\":\"2026-03-11 12:25:10\",\"extension\":\"png\",\"order_by\":5,\"title\":\"Figure 5\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":120109,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cem\\u003ePrevalence of hypertension across CKD 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7\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":118293,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cem\\u003eOtotoxic Drug Usage across CKD patients.\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"7.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8915495/v1/87d6b7077b73b71d3a54c245.png\"},{\"id\":104406191,\"identity\":\"a40ed6f2-7657-44ad-8fb9-5303370177dd\",\"added_by\":\"auto\",\"created_at\":\"2026-03-11 12:25:00\",\"extension\":\"png\",\"order_by\":8,\"title\":\"Figure 8\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":128833,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cem\\u003ePrevalence of Tinnitus among CKD patients.\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"8.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8915495/v1/f02f0fa223c98f066e00df26.png\"},{\"id\":109296412,\"identity\":\"52d39d49-285b-48f9-87bc-d9296ea65a8b\",\"added_by\":\"auto\",\"created_at\":\"2026-05-15 08:46:54\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1224254,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8915495/v1/e7548925-e3c5-448a-8d09-a80c478eda6c.pdf\"},{\"id\":104406376,\"identity\":\"e6733d5d-c2d5-4028-a048-86d802a53cd5\",\"added_by\":\"auto\",\"created_at\":\"2026-03-11 12:25:33\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":109560,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"QuestionaireandResultssheet.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8915495/v1/c4d9f1ed0cba1893483ed66f.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"The Association Between Chronic Kidney Disease and Sensorineural Hearing Loss in Patients at the Colombo North Teaching Hospital Nephrology Clinic, Aged 20- 70 Years\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eAuditory impairment, a common sensory deficit particularly prevalent in the geriatric population (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e), is broadly categorized into sensorineural, conductive, and mixed aetiologies. Sensorineural hearing loss (SNHL), the most frequently encountered type of hearing loss, typically arises from pathology affecting sensory hair cells, synaptic connections, or spiral ganglion neurons (SGNs) within the cochlea (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eChronic kidney disease (CKD) constitutes a substantial global health burden and is associated with an increased incidence of SNHL in affected individuals. In the CKD population, factors such as, hypertension, diabetes mellitus, electrolyte imbalances, haemodialysis and pharmacological interventions are implicated in the pathogenesis of sensorineural hearing loss (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eIn addition, the stages of CKD are classified based on, glomerular filtration rate (GFR) category (G1\\u0026ndash;G5), and albuminuria category (A1\\u0026ndash;A3). The GFR represents the level of kidney function, whereas albuminuria represents the level of albumin in the urine. Stage 1 indicates kidney damage with a normal or high GFR (\\u0026ge;\\u0026thinsp;90 mL/min/1.73 m\\u0026sup2;), whereas stage 2 reflects a mild reduction in the GFR (60\\u0026ndash;89 mL/min/1.73 m\\u0026sup2;). Stage 3a denotes a mild to moderate reduction in the GFR (45\\u0026ndash;59 mL/min/1.73 m\\u0026sup2;), Stage 3b reflects a moderate to severe reduction in the GFR (30\\u0026ndash;44 mL/min/1.73 m\\u0026sup2;), and Stage 4 refers to a severe reduction in the GFR (15\\u0026ndash;29 mL/min/1.73 m\\u0026sup2;). Finally, Stage 5 represents kidney failure, defined by a GFR\\u0026thinsp;\\u0026lt;\\u0026thinsp;15 mL/min/1.73 m\\u0026sup2;. Similarly, A1 indicates a normal to mildly increased level (\\u0026lt;\\u0026thinsp;3 mg/mmol), A2 reflects a moderately increased level (3\\u0026ndash;30 mg/mmol), and A3 indicates a severely increased level (\\u0026gt;\\u0026thinsp;30 mg/mmol). Therefore, either GFR decreases or albuminuria increases, increasing the risk of CKD complications (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eCKD represents a significant public health challenge in Sri Lanka, particularly for middle- and lower-income populations, with hearing loss emerging as a potential and often overlooked comorbidity. Hearing loss can lead to social isolation and communication difficulties among all stages of CKD patients. Notably, routine hearing tests are not standard practice for CKD patients in Sri Lanka and can delay the diagnosis and management of hearing loss in this population. Furthermore, haemodialysis can increase the risk of hearing loss due to exposure to ototoxic medications. Therefore, recognizing these interconnected issues is crucial for developing effective diagnostic and therapeutic approaches for CKD patients in Sri Lanka. Previous studies have not examined the relationship between CKD and SNHL across all stages of CKD. This study, therefore, aimed to assess the prevalence and association of SNHL in patients having CKD.\\u003c/p\\u003e \\u003cp\\u003eSeveral studies have explored the association between CKD and SNHL; however, the underlying mechanisms linking these conditions remain unclear (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e) (\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e). One recent study (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e) found that the findings do not establish a causal link between hearing loss, tinnitus, and chronic kidney disease, highlighting the need for further, more extensive prospective studies to confirm this association. Moreover, CKD is the fourth leading cause of hospitalization and the sixth leading cause of mortality in Sri Lankan hospitals (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e). Data collected in 2020 identified approximately 164,000 individuals affected by CKD in Sri Lanka (\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e). SNHL is the most frequently associated type of hearing loss in patients experiencing CKD (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThis study aimed to evaluate the association between chronic kidney disease (CKD) and sensorineural hearing loss (SNHL) across all CKD stages among adults aged 20\\u0026ndash;70 years attending a tertiary nephrology clinic in Sri Lanka. Although international literature suggests a relationship between CKD and SNHL, evidence from Sri Lanka remains limited, particularly across the full spectrum of CKD severity. Addressing this gap is important for generating context-specific data relevant to local clinical practice.\\u003c/p\\u003e \\u003cp\\u003eBy assessing hearing function using standardized audiometric evaluation, this study sought to quantify the prevalence and severity of SNHL in CKD patients and to explore associated risk factors. Understanding this relationship may support earlier identification of at-risk individuals and inform more comprehensive, multidisciplinary management strategies within nephrology care. Furthermore, locally derived evidence may contribute to improving awareness, screening practices, and long-term outcomes among patients with CKD.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eDesign and setting\\u003c/h2\\u003e \\u003cp\\u003eThis descriptive, cross-sectional, quantitative study recruited patients via random sampling from the Nephrology Clinic at the Colombo North Teaching Hospital in Sri Lanka. The study was conducted at the Audiology Unit of the Ayati Center for Children with Disabilities at the Faculty of Medicine, Ragama, Sri Lanka. The study aimed for a sample size of 305; however, only 121 patients provided consent. Additionally, the sample size was calculated via OpenEpi Version 3 (\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e). This discrepancy, attributed to participant refusal or unavailability, could lead to nonresponse bias if participants who did not respond differ in characteristics from those who did.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eInclusion criteria\\u003c/h3\\u003e\\n\\u003cp\\u003e\\u003cul\\u003e\\u003cli\\u003e\\u003cp\\u003ePatients aged between 20 and 70 years.\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003ePatients who were diagnosed with chronic kidney disease (CKD) and who attended the Nephrology Clinic at Colombo North Teaching Hospital were recruited.\\u003c/p\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cp\\u003e Patients were willing to participate in the study and provided informed written consent.\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/ul\\u003e\\u003c/p\\u003e\\n\\u003ch3\\u003eExclusion criteria\\u003c/h3\\u003e\\n\\u003cp\\u003e \\u003cul\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients younger than 20 years or older than 70 years of age.\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with acute kidney injury or other renal conditions not classified as CKD.\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with a history of congenital hearing loss or other known causes of sensorineural hearing loss not related to CKD.\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with a history of neurodegenerative disorders.\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients who were unwilling or unable to participate or who did not provide informed written consent.\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with uremic encephalopathy, severe illness, or unresponsive patients.\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients with chronic otitis media, tympanosclerosis, and otosclerosis.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/ul\\u003e \\u003c/p\\u003e\\n\\u003ch3\\u003eData collection\\u003c/h3\\u003e\\n\\u003cp\\u003e Data collection commenced after approval from the Ethics Review Committee at the Faculty of Medicine, University of Kelaniya, and the Nephrology Clinic at the Colombo North Teaching Hospital. Moreover, all eligible patients who met the inclusion criteria were enrolled, and informed written consent for participation was obtained. The baseline evaluation was subsequently performed via a researcher-administered questionnaire, which included demographic information; details regarding hearing and hearing difficulties; and participants\\u0026rsquo; histories of kidney disease, as well as pertinent information regarding haemoglobin levels, serum creatinine, serum sodium, serum potassium, serum calcium, serum phosphate, and systolic and diastolic blood pressure from medical laboratory records.\\u003c/p\\u003e \\u003cp\\u003eThe questionnaire used in this study was developed by the research team specifically for this project and is provided as Supplementary File 1\\u003c/p\\u003e \\u003cp\\u003eAn otoscopic examination was subsequently performed, which lasted approximately two minutes. An audiometric evaluation was subsequently conducted to assess both air- and bone-conduction pathways using pure-tone audiometry. The participants wore specialized headphones, commonly used in audiology, that covered their ears and delivered tones at varying frequencies and intensities. They were instructed to press a button to indicate when they perceived each tone. Audiograms were created from their responses to determine hearing thresholds at frequencies ranging from 250 Hz to 8000 Hz. Each test took approximately 10 to 15 minutes.\\u003c/p\\u003e \\u003cp\\u003eFurthermore, the prevalence, correlations, and potential risk factors for sensorineural hearing loss among patients at all stages of chronic kidney disease in the specified age groups were assessed using pure-tone audiometry.\\u003c/p\\u003e\\n\\u003ch3\\u003eData analysis method\\u003c/h3\\u003e\\n\\u003cp\\u003eThe quantitative data were analysed via descriptive statistics with IBM SPSS Statistics for Windows, Version 26.0. Descriptive and inferential statistics were applied. Frequencies and percentages were used for discrete variables. Chi-square tests were conducted to assess differences in proportions. Differences were considered significant if the p-value was less than 0.05. Microsoft Word and Excel were used to create graphs and tables to display the findings.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cem\\u003eGender distribution in patients with CKD (n=121).\\u003c/em\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e shows the sex distribution of the study population (n\\u0026thinsp;=\\u0026thinsp;121) recruited from the Nephrology Clinic at Colombo North Teaching Hospital. The study included 73 men (60.33%) and 48 women (39.67%), with ages ranging from 20 to 70 years. This study provides context for interpreting demographic influences on hearing loss. Moreover, no evaluation was applied, as this is descriptive demographic information.\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003e \\u003cb\\u003eFigure 2\\u003c/b\\u003e \\u003c/p\\u003e\\u003cp\\u003e \\u003cem\\u003eAge-related distribution of sensorineural hearing loss across CKD stages.\\u003c/em\\u003e \\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eFigure 2 indicates the distribution of hearing loss across four subgroups (20\\u0026ndash;30, 31\\u0026ndash;40, 41\\u0026ndash;50, 51\\u0026ndash;60, and 61\\u0026ndash;70 years). The prevalence of SNHL increased with increasing age. Additionally, a chi-square test revealed a significant association between SNHL and CKD stage, with respect to age (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Therefore, this relationship highlights aging as significant factor in SNHL among CKD patients.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"BlockQuote\\\"\\u003e \\u003cp\\u003eThe participants were categorized into five groups as shown in the Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e based on the severity of hearing loss: normal, normal-to-mild, mild-to-moderately-severe, minimal-to-moderately-severe, and mild-to-profound. Among patients with CKD, mild-to-moderately severe hearing loss was the most common degree, whereas normal hearing was more common in the early stages of CKD (stage 1 and stage 2). There was a statistically significant correlation between the degree of SNHL and CKD stage (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), suggesting that the severity of renal dysfunction is associated with the degree of hearing loss.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003ePatients were categorized into five subgroups based on CKD duration: less than 1 year, 1\\u0026ndash;3 years, 3\\u0026ndash;5 years, 5\\u0026ndash;7 years, and more than 7 years. The Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e shows a statistically significant correlation between hearing loss and CKD stage, with respect to CKD duration (p\\u0026thinsp;=\\u0026thinsp;0.010). Therefore, prolonged duration of CKD appears to exacerbate CKD and may also contribute to the progression of hearing loss.\\u003c/p\\u003e \\u003cp\\u003eFigure \\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e\\u003c/p\\u003e \\u003cp\\u003e \\u003cem\\u003ePrevalence of hypertension across CKD stages.\\u003c/em\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eFigure \\u003cspan refid=\\\"Fig5\\\" class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e\\u003c/p\\u003e \\u003cp\\u003e \\u003cem\\u003ePrevalence of Diabetes Mellitus among CKD stages.\\u003c/em\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"BlockQuote\\\"\\u003e \\u003cp\\u003eFigure \\u003cspan refid=\\\"Fig6\\\" class=\\\"InternalRef\\\"\\u003e7\\u003c/span\\u003e displays the occurrence of ototoxic drug use across CKD stages. Usage increased gradually toward stage 5, with frusemide being the most common ototoxic medication reported. In addition, the association between CKD stage and ototoxic drug exposure was significant (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). These findings underscore the importance of medication monitoring in preventing SNHL among patients with CKD.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eFigure \\u003cspan refid=\\\"Fig7\\\" class=\\\"InternalRef\\\"\\u003e8\\u003c/span\\u003e illustrates the distribution of tinnitus among CKD stages. Although tinnitus was most reported in stage 5 patients, the association between tinnitus and CKD stage was not statistically significant (p\\u0026thinsp;=\\u0026thinsp;0.267). These findings indicate that tinnitus incidence varies across CKD stages and may not be directly correlated with renal disease severity.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eComparison of risk factors in CKD patients with and without hearing loss.\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRisk factors\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCKD patients with hearing loss (n\\u0026thinsp;=\\u0026thinsp;104)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCKD patients without hearing loss (n\\u0026thinsp;=\\u0026thinsp;17)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eP value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHypertension (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e91.35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e88.24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.338\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiabetes mellitus (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e82.69\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e41.17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOtotoxic drug exposure (%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e67.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e41.17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.038\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMean age (years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e59.421\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e59.452\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMedian duration of CKD (years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3.15\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.010\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe Table \\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e compares key risk factors, including diabetes mellitus, hypertension, ototoxic drug exposure, age, and CKD duration, between CKD patients with hearing loss (n\\u0026thinsp;=\\u0026thinsp;104) and those without hearing loss (n\\u0026thinsp;=\\u0026thinsp;17). Furthermore, diabetes mellitus (p\\u0026thinsp;=\\u0026thinsp;0.001), ototoxic drug exposure (p\\u0026thinsp;=\\u0026thinsp;0.038), age (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), and CKD duration (p\\u0026thinsp;=\\u0026thinsp;0.010) were significantly associated with hearing loss, whereas hypertension was not (p\\u0026thinsp;=\\u0026thinsp;0.338). These findings emphasize that metabolic and pharmacological factors contribute to SNHL among individuals with CKD.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e\\u003cem\\u003eComparison of blood parameters in CKD patients with and without hearing loss.\\u003c/em\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBlood parameters\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCKD patients with hearing loss (n\\u0026thinsp;=\\u0026thinsp;104)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCKD patients without hearing loss (n\\u0026thinsp;=\\u0026thinsp;17)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eP value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMean haemoglobin (g/dL)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11.43\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11.42\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.904\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMedian serum creatinine (mg/dL)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e182.5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e100\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.011\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMean serum calcium (mmol/L)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.32\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.533\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMean serum potassium (mmol/L)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e4.32\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4.35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.123\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMean serum phosphate (mmol/L)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.22\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.963\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMean serum sodium (mmol/L)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e137.72\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e138.05\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.113\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eThe Table \\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e compares haemoglobin levels, serum creatinine, serum calcium, serum potassium, serum phosphate and serum sodium between CKD patients with hearing loss (n\\u0026thinsp;=\\u0026thinsp;104) and those without hearing loss (n\\u0026thinsp;=\\u0026thinsp;17). Moreover, the median serum creatinine level differed significantly between the groups (p\\u0026thinsp;=\\u0026thinsp;0.011), whereas the other parameters were not significantly different. Chronic kidney disease (CKD) is worsening, as evidenced by increased blood creatinine levels and a statistically significant correlation with the occurrence of hearing loss.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eResearch consistently indicates a correlation between chronic kidney disease (CKD) and sensorineural hearing loss (SNHL). Studies have shown that the SNHL incidence in CKD patients ranges from 54% to 90% (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e) (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e), increasing with CKD progression, with stage V patients exhibiting the highest rates (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e). Similarly, the present study also revealed a strong correlation between all stages of CKD and SNHL (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), identifying it as the most associated type of hearing loss in CKD patients, with a prevalence of 85.95% across all stages.\\u003c/p\\u003e \\u003cp\\u003eMoreover, mild-to-moderately severe sloping hearing loss, often bilateral and symmetric, is most frequently encountered in CKD patients, although its severity varies across stages. Mild to moderate hearing loss is predominant, with the severity fluctuating to profound (\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e) (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e). However, the correlation between CKD stage and hearing loss severity is not consistently observed. Hearing loss is typically bilateral, mild in degree, and primarily affects high frequencies (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e) (\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e). Conversely, (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e) reported that some patients may have had normal hearing, which aligns with the current study's finding that 14% of CKD patients presented with normal hearing.\\u003c/p\\u003e \\u003cp\\u003eThis study focused on identifying potential risk factors for SNHL development in CKD patients, specifically age, CKD duration, comorbidities such as hypertension and diabetes, relevant blood parameters, exposure to ototoxic medications, and tinnitus.\\u003c/p\\u003e \\u003cp\\u003eNotably, the findings revealed a statistically significant correlation between hearing loss and CKD stage, considering factors such as age (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), duration of CKD (p\\u0026thinsp;=\\u0026thinsp;0.010), exposure to ototoxic drugs (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), diabetes mellitus (p\\u0026thinsp;=\\u0026thinsp;0.001) and serum creatinine (p\\u0026thinsp;=\\u0026thinsp;0.011). Consistently, aging, CKD duration, diabetes mellitus, exposure to ototoxic drugs, and serum creatinine levels are significantly correlated with SNHL (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e) (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e) (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e) (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e). In contrast, one study reported that SNHL was not associated with CKD duration (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eFurthermore, there is a notable association between tinnitus and CKD, but not across all CKD stages (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e). Conversely, no significant associations were observed between tinnitus and any stage of CKD (p\\u0026thinsp;=\\u0026thinsp;0.267). Similarly, the present study found no substantial association between hypertension and any stage of CKD (p\\u0026thinsp;=\\u0026thinsp;0.338), consistent with studies reporting no correlation between sensorineural hearing loss and hypertension in CKD patients (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). However, contrasting findings from other studies suggest an elevated risk (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e), potentially due to variations in study demographics, sample sizes, or blood pressure management in Sri Lankan clinical settings.\\u003c/p\\u003e \\u003cp\\u003eIn summary, aging, diabetes mellitus, exposure to ototoxic drugs, elevated serum creatinine levels, and prolonged duration of chronic kidney disease were identified as significant risk factors for hearing loss in this CKD population. Sensorineural hearing loss is also globally prevalent among patients with chronic kidney disease. However, the lack of regular audiological assessments in nephrology clinics and the restricted access to audiology services in Sri Lanka represent significant deficiencies in patient care. Therefore, implementing portable screening audiometry for CKD patients can mitigate the psychosocial effects of untreated hearing loss and improve their quality of life.\\u003c/p\\u003e\\n\\u003ch3\\u003eStrengths of the study\\u003c/h3\\u003e\\n\\u003cp\\u003e \\u003cul\\u003e \\u003cli\\u003e \\u003cp\\u003ePatients across all stages of CKD and age groups (20\\u0026ndash;70 years) were included.\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eFactors contributing to hearing loss were investigated within the CKD population.\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eThe study benefits from recruiting people directly from a hospital setting, which preserves the sample's clinical relevance and representativeness despite a lower participation rate.\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003ePrecise selection criteria were implemented, and comprehensive matching was performed to reduce potential selection bias.\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eDespite a reduced sample size due to declining patient involvement, which may have affected the statistical power and generalizability, the available participants were sufficient to provide reliable insights relevant to the objectives of the study.\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eThe inclusion of both hearing and tinnitus status in the analysis of the CKD population makes this study more comprehensive and provides a broader perspective than analyses focusing solely on hearing status.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/ul\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eLimitations\\u003c/h2\\u003e \\u003cp\\u003e \\u003cul\\u003e \\u003cli\\u003e \\u003cp\\u003eThe cross-sectional observational design prevented the establishment of a causal relationship.\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eThe number of patients enrolled was insufficient to ensure generalizability to the whole population.\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eThis study did not examine potential risk factors such as hemodialysis, serum urea level, and electrolyte imbalances.\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eIn the present study, pure tone audiometry was employed; the use of more sensitive methods, such as otoacoustic emission and auditory brainstem evoked response, could have increased the sensitivity of the study.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/ul\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy implications\\u003c/h2\\u003e \\u003cp\\u003e \\u003cul\\u003e \\u003cli\\u003e \\u003cp\\u003eThe findings of this study underscore the importance of early diagnosis through regular check-ups, along with timely follow-up and appropriate management, to reduce the occurrence of SNHL in CKD patients.\\u003c/p\\u003e \\u003c/li\\u003e \\u003cli\\u003e \\u003cp\\u003eThe study recommends the implementation of systematic audiological screening for all stages of chronic kidney disease (CKD) patients, especially those with comorbidities such as diabetes, exposure to ototoxic medications, extended CKD duration, advanced age, and those receiving hemodialysis.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/ul\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eRecommendations\\u003c/h2\\u003e \\u003cp\\u003eAlthough some patients with chronic kidney disease (CKD) report tinnitus, the precise relationship between CKD progression and tinnitus remains unclear. Well-designed longitudinal and prospective studies are warranted to further explore and clarify this potential association.\\u003c/p\\u003e \\u003cp\\u003eThe present study did not demonstrate significant associations between hearing loss and serum urea levels, electrolyte disturbances, or hemodialysis status. Future research with larger sample sizes and longitudinal designs is recommended to better elucidate the potential contributions of these factors to audiological complications in CKD patients.\\u003c/p\\u003e \\u003cp\\u003eThe possible impact of hemodialysis on hearing function remains inconclusive. Long-term prospective studies are needed to determine whether hemodialysis exerts protective, neutral, or detrimental effects on auditory function in individuals with CKD.\\u003c/p\\u003e \\u003cp\\u003eJudicious prescription and careful monitoring of ototoxic medications are strongly recommended in CKD patients, particularly in advanced stages of disease, to minimize preventable auditory damage.\\u003c/p\\u003e \\u003cp\\u003eRoutine audiological screening should be considered as part of comprehensive CKD management, especially for patients with advanced age, prolonged disease duration, diabetes mellitus, elevated serum creatinine levels, or exposure to ototoxic drugs. Early detection and timely intervention may significantly reduce the psychosocial burden of untreated sensorineural hearing loss (SNHL) and improve overall quality of life.\\u003c/p\\u003e \\u003cp\\u003eFurther translational and mechanistic research exploring the shared physiopathological pathways between renal and cochlear dysfunction may contribute to improved therapeutic strategies and integrated models of care, ultimately enhancing patient-centered outcomes in CKD management.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eSensorineural hearing loss is a common complication observed at the Nephrology Clinic of Colombo North Teaching Hospital in Sri Lanka, with a high prevalence of mild-to-moderately severe bilateral hearing impairment. Evidence indicates a correlation between the progression of chronic kidney disease and the increasing severity of SNHL, suggesting that as CKD progresses, the degree of SNHL also increases, which intensifies with age, duration of CKD, diabetes mellitus, serum creatinine level, and exposure to ototoxic drugs. This study could not establish that hypertension is a risk factor for hearing loss in CKD. The SNHL observed in CKD patients is often irreversible and challenging to manage, significantly reducing their quality of life. Therefore, early detection and improved patient outcomes through periodic hearing screening, prompt follow-up care, and appropriate rehabilitation interventions are crucial for mitigating the occurrence and progression of SNHL in this population. Integrating hearing care into nephrology services in Sri Lanka, where chronic kidney disease is prevalent and healthcare resources are limited, offers a pragmatic solution for enhancing accessibility to comprehensive care.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eCKD\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003echronic kidney disease\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eSNHL\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003esensorineural hearing loss\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eSGNs\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eSpiral ganglion neurons\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eEthical approval for the study was obtained from the Ethics Review Committee of the Faculty of Medicine, University of Kelaniya, Sri Lanka (P/72/04/2024). The study was conducted in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Participants were recruited only after providing informed consent and could withdraw at any time without negative consequences. Informed consent was obtained through telephone; subsequently, the written informed consent form and the participant information sheet were provided prior to the data collection.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot Applicable\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe data that support the findings (individual interview transcripts in English) are not openly available. All the data were treated with strict confidentiality and securely stored in a locked cabinet and on a password-protected computer that was accessible only to the researcher and the supervising faculty member.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe author declares no competing interests.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe researcher personally funded transportation costs for participating patients, considering the Ayati Centre\\u0026apos;s proximity to the Nephrology Clinic at Colombo North Teaching Hospital.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eHL prepared the proposal, conducted the data collection and did the data analyses. MR, NR, HL prepared the main manuscript text. All authors contributed to the discussion of the findings, writing and reviewing the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe author would like to express gratitude to the research supervisor Dr. Maithri Rupasinghe, Senior Lecturer (Grade II) and Head of the Department of Family Medicine, Faculty of Medicine, University of Kelaniya, as well as Dr. Liyanage Ranaweera, Director of Colombo North Teaching Hospital, Ragama, and Dr. Nalaka Herath, Consultant Nephrologist, Nephrology Clinic, Colombo North Teaching Hospital, for granting permission to recruit patients from the hospital.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; information\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u003csup\\u003e1 \\u003c/sup\\u003e\\u003c/em\\u003e\\u003cem\\u003eDepartment of Disabilities Study, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e \\u003csup\\u003e2 \\u003c/sup\\u003eDepartment of Family Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka\\u003c/em\\u003e\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eAgrawal M, Singh CV. 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Am J Kidney Dis. 2010;56(4):661\\u0026ndash;9. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1053/j.ajkd.2010.05.015\\u003c/span\\u003e\\u003cspan address=\\\"10.1053/j.ajkd.2010.05.015\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWeerakoon DCR, Siriwardana EPEDZ, Jayasekara JMKB, Damayanthi HDWT, Dorji T, Lucero-Prisno DE. Chronic kidney disease in Sri Lanka: Health systems challenges of patients on hemodialysis. Public Health Challenges. 2024b;3(1). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1002/puh2.155\\u003c/span\\u003e\\u003cspan address=\\\"10.1002/puh2.155\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eZou Y, Tang X, Rao K, Zhong Y, Chen X, Liang Y, Pi Y. Association between hearing loss, tinnitus, and chronic kidney disease: the NHANES 2015\\u0026ndash;2018. Front Med. 2024;11. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.3389/fmed.2024.1426609\\u003c/span\\u003e\\u003cspan address=\\\"10.3389/fmed.2024.1426609\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003e\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.openepi.com/SampleSize/SSPropor.htm\\u003c/span\\u003e\\u003cspan address=\\\"https://www.openepi.com/SampleSize/SSPropor.htm\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Chronic kidney disease, Sensorineural hearing loss, Nephrology Clinic, Audiological assessments\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8915495/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8915495/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground:\\u003c/h2\\u003e \\u003cp\\u003eAlthough numerous studies have investigated the relationship between chronic kidney disease and sensorineural hearing loss, the specific correlation between these conditions remains insufficiently explored. However, sensorineural hearing loss is a recognized complication in patients with chronic kidney disease. Understanding the connection between CKD and SNHL is crucial for developing effective therapeutic interventions within the medical community. This study aimed to determine the prevalence and correlation of SNHL among patients with CKD and identify associated risk factors.\\u003c/p\\u003e\\u003ch2\\u003eMethods:\\u003c/h2\\u003e \\u003cp\\u003eThis descriptive, cross-sectional study was conducted among 121 CKD patients aged 20\\u0026ndash;70 years who were recruited from the Nephrology Clinic at Colombo North Teaching Hospital. Data were gathered via an interviewer-administered questionnaire and audiological assessments (otoscopy and pure tone audiometry). Random sampling and inferential statistical analysis were performed via SPSS software (version 26). CKD staging was determined by the estimated glomerular filtration rate.\\u003c/p\\u003e\\u003ch2\\u003eResults:\\u003c/h2\\u003e \\u003cp\\u003eAmong 121 patients, the male-to-female ratio was 1.5:1.0. Bilateral hearing loss was observed in 85.95% of the participants, with most cases ranging from mild to moderately severe. However, the degree of hearing loss varies, and there is no clear progression across advanced stages of CKD. The analysis revealed that the severity of SNHL increased with age, prolonged duration of CKD, the presence of diabetes mellitus, and the use of specific ototoxic medications. In contrast, hypertension was not significantly associated with hearing loss.\\u003c/p\\u003e\\u003ch2\\u003eConclusion:\\u003c/h2\\u003e \\u003cp\\u003eSNHL is highly prevalent among CKD patients across all stages. This study emphasizes the importance of regular audiological assessments in the management and follow-up of CKD in Sri Lanka. Furthermore, this study represents one of the initial investigations within Sri Lanka to establish the prevalence of SNHL in CKD patients, contributing context-specific insights to inform clinical management and preventive strategies.\\u003c/p\\u003e\",\"manuscriptTitle\":\"The Association Between Chronic Kidney Disease and Sensorineural Hearing Loss in Patients at the Colombo North Teaching Hospital Nephrology Clinic, Aged 20- 70 Years\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-03-11 06:12:32\",\"doi\":\"10.21203/rs.3.rs-8915495/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"c02228c1-e5c6-42ce-b803-2e9becd15a48\",\"owner\":[],\"postedDate\":\"March 11th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-15T07:55:55+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-03-11 06:12:32\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8915495\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8915495\",\"identity\":\"rs-8915495\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}