The relationship between sensorineural hearing loss and chronic kidney disease: Results from a population-based cohort study

The relationship between sensorineural hearing loss and chronic kidney disease: Results from a population-based cohort study | 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 Article The relationship between sensorineural hearing loss and chronic kidney disease: Results from a population-based cohort study Arash Bayat, Nader Saki, Bahman Cheraghian, Ali Ghorbani, Zahra Rahimi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6529557/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 Chronic kidney disease (CKD) is a significant public health issue associated with multiple complications, including hearing loss. This population-based cross-sectional study, conducted from 2017 to 2021 in southwest Iran, evaluated the relationship between CKD and sensorineural hearing loss (SNHL) among 1,365 participants aged 35–70 years from the Hoveyzeh ear cohort study. Demographic data, comorbidities (e.g., diabetes, hypertension), CKD status, and hearing information were analyzed. After adjusting for confounders via multiple logistic regression, CKD was significantly associated with SNHL (adjusted OR = 2.19; 95% CI: 1.16–4.13). The prevalence of SNHL in CKD patients was 70.49% (95% CI: 57.94–80.56). Age, male gender, diabetes, noise exposure, and ear infections were also linked to higher odds of SNHL, while hypertension showed no significant association. These findings highlight CKD as an independent risk factor for SNHL and underscore the importance of monitoring hearing health in CKD patients to address comorbid complications. Health sciences/Diseases Health sciences/Medical research Health sciences/Molecular medicine Health sciences/Risk factors Sensorineural hearing loss Chronic kidney disease Iran Figures Figure 1 Figure 8 Introduction Hearing loss is a major global health concern, affecting approximately 1.6 billion people and ranking as the third-leading cause of disability worldwide 1 . Projections suggest that by 2050, nearly 2.5 billion individuals will experience some degree of hearing impairment, with the burden disproportionately affecting low- and middle-income countries (LMICs), where 80% of cases remain unaddressed 2 – 5 . Despite this, cost-effective solutions exist—an annual investment of just $ 1.33 per capita could expand hearing care coverage to 90% of those in need 2 . Similarly, chronic kidney disease (CKD) is a pervasive condition, defined by persistent kidney dysfunction lasting over three months, and is linked to increased mortality, morbidity, and healthcare costs 1 , 6 . Globally, CKD affects 9.5–13% of the population—roughly 700 million to one billion people—and is associated with hypertension, cardiovascular disease, anemia, and notably, hearing loss 7 – 9 . Emerging evidence suggests a pathophysiological link between CKD and sensorineural hearing loss (SNHL), likely due to shared electrolyte transport mechanisms, structural similarities between the kidney and cochlea, and common risk factors such as ototoxic medications, hypertension, and electrolyte imbalances 10 – 14 . However, existing studies on this association remain limited by small sample sizes, a focus on end-stage kidney disease, and inconsistent findings 15 , 16 . For instance, while Seo et al. reported a higher prevalence of SNHL in CKD patients using Korean national survey data, their analysis was restricted to two eGFR groups 17 . Conversely, Gupta et al. found no significant correlation between eGFR and SNHL risk 18 . This study aims to determine the prevalence of SNHL across different CKD stages in a Southwest Iranian population, while identifying key risk factors and underlying mechanisms. By clarifying this relationship, we hope to inform clinical practice, promote interdisciplinary collaboration (e.g., between nephrologists and otolaryngologists), and ultimately improve patient outcomes and quality of life. Results The study cohort comprised 1,365 participants with a mean age of 48.96 ± 8.94 years, of whom 841 (61.61%) were female. SNHL was significantly more prevalent among older adults, with 65.1% of individuals aged ≥ 56 years affected ( p < .001). Males showed a notably higher prevalence of SNHL compared to females (50.2% vs. 26.4%, p < .001). Lower educational attainment was also associated with higher SNHL prevalence, particularly among illiterate individuals (38.9%, p = .023). Those with a history of noise exposure (65.0%), ear infections (50.7%), diabetes (50.7%), hypertension (48.4%), or chronic kidney disease (70.5%) had significantly higher rates of SNHL (all p < .01). Conversely, place of residence (urban vs. rural) showed no significant association ( p = .519). Obesity, overweight, and underweight status were all associated with SNHL, with higher prevalence observed in individuals with lower or higher BMI than normal ( p < .001). These findings highlight that age, sex, comorbid conditions, and environmental exposures are strongly associated with SNHL (Table 1 ). Table 1 Demographic, and comorbidity characteristics by hearing status of the participants Variable with SNHL n = 485, n(%) without SNHL n = 880, n(%) P-value * Age category < 0.001 * 35–45 years 498(85.27) 46–55 years 179 (40.41) 264(59.59) ≥56 years 220 (65.09) 118 (34.91) Sex < 0.001 * Male 263 (50.19) 261 (49.81) Female 222(26.40) 619(73.60) Education levels 0.023 * Illiteracy 323(38.87) 508(61.13) Primary school 77(32.35) 161(67.65) Secondary school 32(30.48) 73(69.52) High school and Diploma 29(28.16) 74(71.84) University 24(27.27) 64(72.73) Residence Type 0.519 Urban 309(34.92) 576(65.08) Rural 176(36.67) 304(63.33) Noise exposure history < 0.001 * Yes 141 (64.98) 76 ( 35.02) No 344(29.97) 804(70.03) Ear infection history 0.005 * Yes 38(50.67) 37(49.33) No 447(34.65) 843(65.35) Body mass index < 0.001 * Underweight 6(50) 6(50) Normal 118(46.27) 137(53.73) Overweight 182(33.89) 355(66.11) Obese 179(31.91) 382(68.09) Diabetes history < 0.001 * Yes 153 (50.66) 149 (49.34) No 332(31.23) 731(68.77) Hypertension history < 0.001 * Yes 182 (48.40) 194 (51.60) No 303(30.64) 686(69.36) Chronic kidney disease < 0.001 * Yes 43(70.49) 18(29.51) No 442(33.90) 862(66.10) *p-value < 0.05 was considered a statistically significant level in the chi-square test SNHL: Sensorineural Hearing Loss Among participants with SNHL, the distribution of estimated glomerular filtration rate (e-GFR) stages showed a clear trend toward poorer kidney function. SNHL was significantly more common in individuals with reduced kidney function, particularly those in stages G3a to G4. For example, 67.9% of individuals with e-GFR stage G3a (mild to moderate decrease) and all individuals with stage G4 (severely decreased kidney function) had SNHL, compared to only 26.2% of those in the normal/high e-GFR group (p < .001)(Table 2 ). Table 2 Staging of chronic kidney disease calculated by Cockcroft Gault formula by sensorineural hearing loss (SNHL) e-GFR category with SNHL N = 485, n(%) without SNHL N = 880, n(%) p-value G1: Normal or high 225 (26.16) 635 (73.84) < 0.001 * G2: Mildly decrease 217 (48.87) 227 (51.13) G3a: Mildly to Moderate 36 (67.92) 17 (32.08) G3b: Moderately to severe 4 (80.00) 1 (20.00) G4: severely decreased 3 (100.00) 0 (0.00) *P < 0.05 was considered a statistically significant level in the fisher`s exact test e-GFR: e-Glomerular Filtration Rate The crude and adjusted odds ratios derived from the logistic regression analysis are presented in Table 3 . In the unadjusted model, all variables except for residence type, BMI, and educational level demonstrated statistically significant associations with sensorineural hearing loss (SNHL) ( p < .05). After adjusting for age, sex, hypertension, diabetes, history of ear infections, and noise exposure, CKD remained significantly associated with SNHL, with individuals affected by CKD having more than twice the odds of hearing loss compared to those without CKD (adjusted OR = 2.19, 95% CI [1.16, 4.13]). Participants aged 46 − 55 years had nearly four times the odds of SNHL (OR = 3.93, 95% CI [2.85, 5.43]), while those aged 56 years or older had more than nine times the odds (OR = 9.23, 95% CI [6.41, 13.28]) relative to the 35–45 age group. Males had significantly higher odds of SNHL than females (OR = 2.26, 95% CI [1.71, 3.00]). Additionally, diabetes was associated with a 55% increase in the odds of SNHL (OR = 1.55, 95% CI [1.14, 2.10]). A history of noise exposure was strongly associated with SNHL, with exposed individuals exhibiting more than three times the odds of hearing loss compared to unexposed individuals (OR = 3.22, 95% CI [2.23, 4.66]). Similarly, participants with a history of ear infections had significantly higher odds of SNHL (OR = 1.95, 95% CI [1.12, 3.43]). No statistically significant association was observed between hypertension and hearing impairment. Table 3 Crude and adjusted odds ratios (ORs) for patients with sensorineural hearing loss using the logistic regression model Crude Odds Ratio (CI 95%) P-value * Adjusted Odds Ratio (CI 95%) P-value * Age groups 35–45 y 1 46–55 y 3.93 2.92–5.29 < 0.001 3.93 2.85–5.43 =56 y 10.80 7.84–14.86 < 0.001 9.23 6.41–13.28 < 0.001 Sex Male 2.80 2.23–3.53 < 0.001 2.26 1.71-3.00 < 0.001 Female 1 Education levels Illiteracy 1 Primary school 0.75 0.55–1.02 0.068 - - Secondary school 0.69 0.44 − 0.1.07 0.096 - - High school and Diploma 0.62 0.39–0.97 0.036 - - University 0.59 0.36–0.96 0.034 - - BMI Underweight 1 - - Normal 0.86 0.27–2.7 0.801 - - Overweight 0.51 0.16–1.61 0.253 - - Obese 0.47 0.15–1.47 0.195 - - Type of Residence Urban 1.08 0.86–1.36 0.519 - - Rural 1 Diabetes Yes 2.26 1.74–2.93 < 0.001 1.55 1.14–2.10 0.005 No 1 1 Hypertension Yes 2.12 1.66–2.71 < 0.001 1.16 0.86–1.56 0.331 No 1 1 Noise exposure history Yes 4.34 3.19–5.89 < 0.001 3.22 2.23–4.66 < 0.001 No 1 1 Ear infection history Yes 1.94 1.21–3.09 < 0.001 1.95 1.12–3.43 0.019 No 1 1 Chronic kidney disease Yes 4.65 2.66–8.17 < 0.001 2.19 1.16–4.13 0.015 No 1 1 *P < 0.05 significant for the logistic regression model Discussion The present study aimed to determine the prevalence of SNHL in different stages of CKD. Among 1365 participants, the overall prevalence of SNHL was found to be 35.53%. SNHL was more prevalent among older adults, males, and individuals with chronic conditions such as diabetes, CKD, and a history of ear infections or noise exposure. These associations were futher confirmed through logistic regression analysis, which identified older age, male sex, diabetes, noise exposure, and ear infections as strong predictors of SNHL. Additionally, CKD was independently and significantly associated with hearing loss. Conversely, no significant associations were observed for residence type, body mass index, or education level after adjusting for confounding factors. The prevalence of SNHL in individuals with CKD exceeds 70%, though reported rates vary significantly across different regions. Studies have documented SNHL prevalence rates of 41.7% in India 19 , 54% in Bangladesh 20 , 76.3% in Iraq 21 , and 58.5% in Nigeria 22 . Direct comparisons between these studies and the current findings are complicated by differences in participant demographics (e.g., age groups), diagnostic criteria for hearing loss, and assessment methods—such as self-reporting versus pure-tone audiometry. These regional disparities may stem from genetic factors, environmental influences, variations in healthcare access, and differences in CKD management quality. Additionally, lifestyle factors, exposure to ototoxic medications, and the presence of comorbidities may further contribute to the observed variability in SNHL prevalence among CKD patients. Our study found a significant association between SNHL and CKD based on adjusted odds ratios, aligning with previous research 11 , 23 , 24 . Wu et al. 24 examined SNHL and related comorbidities in CKD patients, reporting a substantially higher risk of hearing loss in individuals with CKD compared to those without. Additionally, they identified an elevated risk of SNHL in CKD patients with concurrent conditions such as hypertension, diabetes mellitus, heart failure, and liver cirrhosis. Similarly, Seo et al. 11 demonstrated that patients with an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² had 1.25 times higher odds of SNHL than those with eGFR ≥ 60 mL/min/1.73 m², even after adjusting for age, sex, smoking, alcohol consumption, body mass index, hypertension, diabetes mellitus, dyslipidemia, and microalbuminuria. This study has identified a statistically significant association between sex and sensorineural hearing loss (SNHL). The underlying mechanisms likely involve sex-specific differences in hearing preservation and susceptibility to damage. It has been suggested that females may retain better hearing than males following noise exposure and aging, possibly due to the protective role of estrogen in cochlear function 25 . This hormone is thought to modulate pathophysiological processes in the inner ear, potentially shielding the auditory system from degeneration. Similarly, age exhibited a significant relationship with SNHL, consistent with the natural decline in hearing acuity over time. Age-related hearing loss can be attributed to cumulative noise exposure, ototoxic medication use, cardiovascular risk factors, and the progressive degeneration of cochlear hair cells and auditory nerve fibers 26 . Our study demonstrated a significant association between diabetes and sensorineural hearing loss (SNHL). This relationship may be attributed to diabetes-induced macro- and microvascular damage, which can impair cochlear function through multiple mechanisms. Chronic hyperglycemia may lead to reduced blood flow to the inner ear, compromising oxygen delivery and disrupting ion transport in the cochlea's highly vascularized tissues 27 . Furthermore, diabetic microangiopathy can induce structural changes in the cochlea, including nerve fiber degeneration, demyelination, and potential auditory nerve damage 28 . These pathological changes collectively contribute to the development of SNHL in diabetic patients. The results revealed a significant association between ear infections and SNHL. This relationship may stem from infection-induced damage to inner ear structures and the auditory nerve. Chronic suppurative otitis media, in particular, has been consistently linked to SNHL in clinical studies 29 . Such infections can progress beyond the middle ear, potentially damaging cochlear hair cells or disrupting neural transmission pathways. The inflammatory response and bacterial toxins associated with persistent infections may directly impair the delicate sensory structures of the inner ear, leading to permanent hearing loss. A statistically significant association was observed between chronic noise exposure, particularly in occupational settings, and the development and progression of SNHL, highlighting noise as a major modifiable risk factor 30 . This relationship is biologically plausible, as excessive noise exposure causes mechanical and metabolic damage to the cochlea's delicate structures, including the irreversible destruction of hair cells and degeneration of auditory nerve fibers, which are critical for sound transduction 31 . The main strengths of the current study include the large-scale dataset and strict quality control process, which enhance the generalizability of the findings to a wider population. Furthermore, utilizing data from a cohort study with a large sample size will provide strong statistical power to identify an association between SNHL and CKD. Additionally, the eGFR was measured using a standard kit and instrument by a laboratory expert. Hearing loss was diagnosed with standard instruments by an audiologist, and the hearing evaluations were confirmed by an otolaryngologist. This process increased the validity and accuracy of the findings regarding the relationship between SNHL and CKD. However, certain limitations must also be noted. Due to the cross-sectional design of the present study, causal inferences could not be drawn. Second, information concerning external or middle-ear pathology, congenital hearing loss, and albuminuria, which could potentially confound the association between SNHL and SKD, was not available in our study. Conclusion These results demonstrate a clinically significant burden of SNHL in individuals with CKD. The strong independent association between CKD and SNHL, alongside modifiable risk factors like noise exposure and comorbidities such as diabetes, underscores the need for targeted hearing screenings in CKD care pathways—particularly for high-risk subgroups (e.g., older males with diabetes or occupational noise exposure). While non-modifiable factors like age and sex further refine risk stratification, the absence of links to BMI or education reinforces the importance of prioritizing clinical and environmental predictors. The cross-sectional nature of this study necessitates longitudinal research to establish causality and unravel the pathophysiological interplay between CKD and SNHL. Until then, proactive management of modifiable risks and early auditory monitoring in CKD populations are critical to mitigating this dual health burden. Methods Study Design and Participants This population-based cross-sectional study analyzed baseline data from the Hoveyzeh Ear Cohort Study (HEC), a sub-study of the Hoveyzeh Cohort Study designed to evaluate hearing status in adults aged 35–70 years in southwest Iran 32 , 33 . All participants underwent comprehensive audiological evaluations, excluding those with chronic neurological disorders, inner ear pathology, otosclerosis, current ototoxic medication use, or history of traumatic brain injury (Fig. 1 ). Audiology Assessment All participants underwent comprehensive audiological evaluations beginning with a detailed case history questionnaire assessing auditory/vestibular symptoms (tinnitus, dizziness, aural fullness, hearing loss), noise exposure history, head trauma, ototoxic drug use, ear surgeries, infections, and systemic diseases (hypertension, diabetes). Middle ear function was evaluated using the AT235 impedance audiometer (Interacoustics, Denmark), while hearing thresholds were measured via pure-tone audiometry in a sound-attenuated booth using a calibrated AD528 clinical audiometer (Interacoustics, Denmark), testing air conduction (250–8000 Hz) and bone conduction (250–4000 Hz). Hearing loss severity was classified by pure-tone average (PTA: 500, 1000, 2000, 4000 Hz) as mild (26–40 dB HL), moderate (41–55 dB HL), moderate-severe (56–70 dB HL), severe (71–90 dB HL), or profound (> 90 dB HL) 12 , 34 . Definition of covariates The analysis included demographic variables (age groups: 35–39, 40–44, 45–49, 50–54, 55–59, 60–64, and ≥ 65 years; sex(male/female); residence type (urban/rural)), education level (illiterate to university), otologic history (ear infections, noise exposure), and health indicators: BMI (underweight < 18.5, normal 18.5–24.9, overweight 25-29.9, obese ≥ 30), diabetes (fasting glucose ≥ 126 mg/dL, medication use, or self-reported diagnosis), hypertension (BP ≥ 140/90 mmHg, antihypertensive use, or self-reported diagnosis), and chronic kidney disease (CKD) defined as eGFR < 60 mL/min/1.73 m² calculated using the Cockcroft-Gault formula: CrCl = [(140-age)×weight×(0.85 if female)]/(72×serum creatinine) 35 . Statistical analysis All analyses were performed using STATA 15 (StataCorp, College Station, TX). Continuous variables were summarized as mean ± standard deviation (SD), while categorical variables were reported as frequencies and percentages. Initial associations were assessed using chi-square tests (χ²) and crude odds ratios in univariate analyses. Potential confounders (e.g., age, sex, education level) were adjusted for in multiple logistic regression models, with variables showing p < 0.2 in univariate analyses eligible for inclusion. Statistical significance was defined as p < 0.05 for all final models. Declarations Acknowledgements The authors would like to thank all those involved in this study and the staff who helped in data collection. Also, the Vice-Chancellor for Research at Ahvaz Jundishapur University of Medical Sciences was as funding organizations. Ethical approval The study protocol was approved by the local Ethics Committee (Ethics code:IR.AJUMS.REC.1402.496) and was conducted in accordance with the Helsinki Declaration. On the registration day, informed written consent was obtained from all participants[grant number HRC-0203]. Conflict of interest The authors declare that there are no competing interests related to this manuscript. Funding This research was funded by the Vice-Chancellor for Research at Ahvaz Jundishapur University of Medical Sciences [grant number HRC-0203]. The Vice-Chancellor for Research at Ahvaz Jundishapur University of Medical Sciences as our funding body played no role in the design of the study and gathering, analysis, and interpretation of data and in writing the manuscript. Author contributions Nader Saki: Conceptualization, Writing- Reviewing and Editing. Zahra Rahimi: Conceptualization, Data Curation, Writing- Reviewing and Editing and Formal analysis. Bahman Cheraghian: Methodology, Formal analysis, Writing- Reviewing and Editing. Arash Bayat: Investigation, Writing- Reviewing and Editing. Ali Ghorbani: Validation, Supervision. Availability of data and materials Upon request, we can offer onsite access to external researchers to the data analyzed at Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. To do so, Dr. Rahimi should be contacted. References Greenberg, D., Rosenblum, N. D. & Tonelli, M. The multifaceted links between hearing loss and chronic kidney disease. Nature Reviews Nephrology , doi:10.1038/s41581-024-00808-2 (2024). Chadha, S., Kamenov, K. & Cieza, A. The world report on hearing, 2021. Bulletin of the World Health Organization 99 , 242 (2021). Haile, L. M. et al. Hearing loss prevalence and years lived with disability, 1990–2019: findings from the Global Burden of Disease Study 2019. The Lancet 397 , 996-1009 (2021). Wilson, B. S., Tucci, D. L., Merson, M. H. & O'Donoghue, G. M. Global hearing health care: new findings and perspectives. The Lancet 390 , 2503-2515 (2017). Rahimi, Z., Saki, N., Cheraghian, B., Amini, P. & Solaymani Dodaran, M. 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Medical journal of the Islamic Republic of Iran 34 , 141 (2020). Davis, A. C. & Hoffman, H. J. Hearing loss: rising prevalence and impact. Bulletin of the World Health Organization 97 , 646 (2019). Sodhi, J. K., Sarin, V. & Chandey, M. To Study the Effect of Chronic Kidney Disease on Hearing Function of the Patients in a Tertiary Care Centre of North India. (2021). Additional Declarations No competing interests reported. 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. We do this by developing innovative software and high quality services for the global research community. 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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-6529557","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":503819212,"identity":"e7b4ca0b-753d-4e5b-bce0-32549428fff9","order_by":0,"name":"Arash Bayat","email":"","orcid":"","institution":"Ahvaz Jundishapur University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Arash","middleName":"","lastName":"Bayat","suffix":""},{"id":503819215,"identity":"e05aaee1-2f65-42ac-b277-5226d5abbe22","order_by":1,"name":"Nader Saki","email":"","orcid":"","institution":"Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Nader","middleName":"","lastName":"Saki","suffix":""},{"id":503819217,"identity":"4adac3b8-a8a8-43bb-b04c-0a7be98e509e","order_by":2,"name":"Bahman Cheraghian","email":"","orcid":"","institution":"Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Bahman","middleName":"","lastName":"Cheraghian","suffix":""},{"id":503819219,"identity":"95da5b55-012e-4c41-82b6-a4069710f600","order_by":3,"name":"Ali Ghorbani","email":"","orcid":"","institution":"Ahvaz Jundishapur University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Ghorbani","suffix":""},{"id":503819221,"identity":"81a28cc2-6677-45c2-b9aa-cc0a30cc6130","order_by":4,"name":"Zahra Rahimi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYBAC+wYGNoYEBol6++MNQK6BBWEtjFAtCQxnDoC0SBCpBQgSGG4kgGgitDBLH3724GGORR7jzOdXN/wokGDgb+9OwKuFjS/N3CBxm0Qxs3RO2c0eoMMkzpzdgFcLDw+DmQRQC2ObdE7aDR6gFgOJXPxaJHjYv4G19EieSbv5hxgtBjw8YFsSZ0iwH7tNlC1ALWUgLcYGPDlst2UMJHgI+sW+h32b5M9tdXIG7Mef3Xzzx0aOv70XvxYkwGMAJolVDgLsD0hRPQpGwSgYBSMIAADL10FZDa42/AAAAABJRU5ErkJggg==","orcid":"","institution":"Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Rahimi","suffix":""}],"badges":[],"createdAt":"2025-04-25 13:53:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6529557/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6529557/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89656988,"identity":"c48e82f0-06e3-4910-a2e6-7c241f0c277d","added_by":"auto","created_at":"2025-08-22 10:31:57","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":156316,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the participants in this study\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6529557/v1/6d252e6e1618d0cb7aaa0e0b.jpeg"},{"id":89656998,"identity":"b526095e-0ce5-41bf-a1b6-fdaaa738f46b","added_by":"auto","created_at":"2025-08-22 10:31:58","extension":"jpeg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":156316,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the participants in this study\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6529557/v1/4cf67d500ce5f4ae45743b1b.jpeg"},{"id":89799208,"identity":"c0300de6-f8db-4c07-b5fd-10996f1ce268","added_by":"auto","created_at":"2025-08-25 07:47:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1392727,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6529557/v1/13f768fa-3676-4752-82c4-8257e44691bc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The relationship between sensorineural hearing loss and chronic kidney disease: Results from a population-based cohort study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHearing loss is a major global health concern, affecting approximately 1.6\u0026nbsp;billion people and ranking as the third-leading cause of disability worldwide \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Projections suggest that by 2050, nearly 2.5\u0026nbsp;billion individuals will experience some degree of hearing impairment, with the burden disproportionately affecting low- and middle-income countries (LMICs), where 80% of cases remain unaddressed \u003csup\u003e\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Despite this, cost-effective solutions exist\u0026mdash;an annual investment of just \u003cspan\u003e$\u003c/span\u003e1.33 per capita could expand hearing care coverage to 90% of those in need \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSimilarly, chronic kidney disease (CKD) is a pervasive condition, defined by persistent kidney dysfunction lasting over three months, and is linked to increased mortality, morbidity, and healthcare costs \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Globally, CKD affects 9.5\u0026ndash;13% of the population\u0026mdash;roughly 700\u0026nbsp;million to one billion people\u0026mdash;and is associated with hypertension, cardiovascular disease, anemia, and notably, hearing loss \u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eEmerging evidence suggests a pathophysiological link between CKD and sensorineural hearing loss (SNHL), likely due to shared electrolyte transport mechanisms, structural similarities between the kidney and cochlea, and common risk factors such as ototoxic medications, hypertension, and electrolyte imbalances \u003csup\u003e\u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHowever, existing studies on this association remain limited by small sample sizes, a focus on end-stage kidney disease, and inconsistent findings \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. For instance, while Seo et al. reported a higher prevalence of SNHL in CKD patients using Korean national survey data, their analysis was restricted to two eGFR groups \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Conversely, Gupta et al. found no significant correlation between eGFR and SNHL risk \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis study aims to determine the prevalence of SNHL across different CKD stages in a Southwest Iranian population, while identifying key risk factors and underlying mechanisms. By clarifying this relationship, we hope to inform clinical practice, promote interdisciplinary collaboration (e.g., between nephrologists and otolaryngologists), and ultimately improve patient outcomes and quality of life.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study cohort comprised 1,365 participants with a mean age of 48.96\u0026thinsp;\u0026plusmn;\u0026thinsp;8.94 years, of whom 841 (61.61%) were female. SNHL was significantly more prevalent among older adults, with 65.1% of individuals aged\u0026thinsp;\u0026ge;\u0026thinsp;56 years affected (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Males showed a notably higher prevalence of SNHL compared to females (50.2% vs. 26.4%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). Lower educational attainment was also associated with higher SNHL prevalence, particularly among illiterate individuals (38.9%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.023). Those with a history of noise exposure (65.0%), ear infections (50.7%), diabetes (50.7%), hypertension (48.4%), or chronic kidney disease (70.5%) had significantly higher rates of SNHL (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01). Conversely, place of residence (urban vs. rural) showed no significant association (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.519). Obesity, overweight, and underweight status were all associated with SNHL, with higher prevalence observed in individuals with lower or higher BMI than normal (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). These findings highlight that age, sex, comorbid conditions, and environmental exposures are strongly associated with SNHL (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\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\u003eDemographic, and comorbidity characteristics by hearing status of the participants\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=\"left\" 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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ewith SNHL\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;485, n(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ewithout SNHL\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;880, n(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge category\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35\u0026ndash;45 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e498(85.27)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e46\u0026ndash;55 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e179 (40.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e264(59.59)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;56 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e220 (65.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e118 (34.91)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e263 (50.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e261 (49.81)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e222(26.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e619(73.60)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation levels\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u003cb\u003e0.023\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIlliteracy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e323(38.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e508(61.13)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77(32.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e161(67.65)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32(30.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73(69.52)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school and Diploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29(28.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" 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colname=\"c2\"\u003e\u003cp\u003e309(34.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e576(65.08)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e176(36.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e304(63.33)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNoise exposure history\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e141 (64.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76 ( 35.02)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e344(29.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e804(70.03)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEar infection history\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38(50.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37(49.33)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e447(34.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e843(65.35)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBody mass index\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6(50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6(50)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e118(46.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e137(53.73)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e182(33.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e355(66.11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObese\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e179(31.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e382(68.09)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiabetes history\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e153 (50.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e149 (49.34)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e332(31.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e731(68.77)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHypertension history\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e182 (48.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e194 (51.60)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e303(30.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e686(69.36)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChronic kidney disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43(70.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(29.51)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e442(33.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e862(66.10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered a statistically significant level in the chi-square test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eSNHL: Sensorineural Hearing Loss\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAmong participants with SNHL, the distribution of estimated glomerular filtration rate (e-GFR) stages showed a clear trend toward poorer kidney function. SNHL was significantly more common in individuals with reduced kidney function, particularly those in stages G3a to G4. For example, 67.9% of individuals with e-GFR stage G3a (mild to moderate decrease) and all individuals with stage G4 (severely decreased kidney function) had SNHL, compared to only 26.2% of those in the normal/high e-GFR group (p\u0026thinsp;\u0026lt;\u0026thinsp;.001)(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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\u003eStaging of chronic kidney disease calculated by Cockcroft Gault formula by sensorineural hearing loss (SNHL)\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ee-GFR category\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ewith SNHL\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;485, n(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ewithout SNHL\u003c/p\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;880, n(%)\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\u003eG1: Normal or high\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e225 (26.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e635 (73.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt; 0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG2: Mildly decrease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e217 (48.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e227 (51.13)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG3a: Mildly to Moderate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36 (67.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17 (32.08)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG3b: Moderately to severe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (80.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (20.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG4: severely decreased\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (100.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0 (0.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered a statistically significant level in the fisher`s exact test\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003ee-GFR: e-Glomerular Filtration Rate\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe crude and adjusted odds ratios derived from the logistic regression analysis are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. In the unadjusted model, all variables except for residence type, BMI, and educational level demonstrated statistically significant associations with sensorineural hearing loss (SNHL) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05). After adjusting for age, sex, hypertension, diabetes, history of ear infections, and noise exposure, CKD remained significantly associated with SNHL, with individuals affected by CKD having more than twice the odds of hearing loss compared to those without CKD (adjusted OR\u0026thinsp;=\u0026thinsp;2.19, 95% CI [1.16, 4.13]). Participants aged 46 \u0026minus;\u0026thinsp;55 years had nearly four times the odds of SNHL (OR\u0026thinsp;=\u0026thinsp;3.93, 95% CI [2.85, 5.43]), while those aged 56 years or older had more than nine times the odds (OR\u0026thinsp;=\u0026thinsp;9.23, 95% CI [6.41, 13.28]) relative to the 35\u0026ndash;45 age group. Males had significantly higher odds of SNHL than females (OR\u0026thinsp;=\u0026thinsp;2.26, 95% CI [1.71, 3.00]). Additionally, diabetes was associated with a 55% increase in the odds of SNHL (OR\u0026thinsp;=\u0026thinsp;1.55, 95% CI [1.14, 2.10]). A history of noise exposure was strongly associated with SNHL, with exposed individuals exhibiting more than three times the odds of hearing loss compared to unexposed individuals (OR\u0026thinsp;=\u0026thinsp;3.22, 95% CI [2.23, 4.66]). Similarly, participants with a history of ear infections had significantly higher odds of SNHL (OR\u0026thinsp;=\u0026thinsp;1.95, 95% CI [1.12, 3.43]). No statistically significant association was observed between hypertension and hearing impairment.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCrude and adjusted odds ratios (ORs) for patients with sensorineural hearing loss using the logistic regression model\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCrude\u003c/p\u003e\u003cp\u003eOdds Ratio\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(CI 95%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP-value\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e(CI 95%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP-value\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge groups\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35\u0026ndash;45 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e46\u0026ndash;55 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.92\u0026ndash;5.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.85\u0026ndash;5.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;=56 y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.84\u0026ndash;14.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6.41\u0026ndash;13.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.23\u0026ndash;3.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.71-3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation levels\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIlliteracy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.55\u0026ndash;1.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.068\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.44\u0026thinsp;\u0026minus;\u0026thinsp;0.1.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.096\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh school and Diploma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.39\u0026ndash;0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.36\u0026ndash;0.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnderweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNormal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.27\u0026ndash;2.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.801\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverweight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.16\u0026ndash;1.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObese\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.15\u0026ndash;1.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eType of Residence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.86\u0026ndash;1.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.519\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiabetes\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.74\u0026ndash;2.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.14\u0026ndash;2.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHypertension\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.66\u0026ndash;2.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.86\u0026ndash;1.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.331\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNoise exposure history\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.19\u0026ndash;5.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.23\u0026ndash;4.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEar infection history\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.21\u0026ndash;3.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.12\u0026ndash;3.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eChronic kidney disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.66\u0026ndash;8.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.16\u0026ndash;4.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 significant for the logistic regression model\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study aimed to determine the prevalence of SNHL in different stages of CKD. Among 1365 participants, the overall prevalence of SNHL was found to be 35.53%. SNHL was more prevalent among older adults, males, and individuals with chronic conditions such as diabetes, CKD, and a history of ear infections or noise exposure. These associations were futher confirmed through logistic regression analysis, which identified older age, male sex, diabetes, noise exposure, and ear infections as strong predictors of SNHL. Additionally, CKD was independently and significantly associated with hearing loss. Conversely, no significant associations were observed for residence type, body mass index, or education level after adjusting for confounding factors.\u003c/p\u003e\u003cp\u003eThe prevalence of SNHL in individuals with CKD exceeds 70%, though reported rates vary significantly across different regions. Studies have documented SNHL prevalence rates of 41.7% in India \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e, 54% in Bangladesh \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, 76.3% in Iraq \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e, and 58.5% in Nigeria \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Direct comparisons between these studies and the current findings are complicated by differences in participant demographics (e.g., age groups), diagnostic criteria for hearing loss, and assessment methods\u0026mdash;such as self-reporting versus pure-tone audiometry. These regional disparities may stem from genetic factors, environmental influences, variations in healthcare access, and differences in CKD management quality. Additionally, lifestyle factors, exposure to ototoxic medications, and the presence of comorbidities may further contribute to the observed variability in SNHL prevalence among CKD patients.\u003c/p\u003e\u003cp\u003eOur study found a significant association between SNHL and CKD based on adjusted odds ratios, aligning with previous research \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Wu et al. \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e examined SNHL and related comorbidities in CKD patients, reporting a substantially higher risk of hearing loss in individuals with CKD compared to those without. Additionally, they identified an elevated risk of SNHL in CKD patients with concurrent conditions such as hypertension, diabetes mellitus, heart failure, and liver cirrhosis. Similarly, Seo et al. \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e demonstrated that patients with an estimated glomerular filtration rate (eGFR)\u0026thinsp;\u0026lt;\u0026thinsp;60 mL/min/1.73 m\u0026sup2; had 1.25 times higher odds of SNHL than those with eGFR\u0026thinsp;\u0026ge;\u0026thinsp;60 mL/min/1.73 m\u0026sup2;, even after adjusting for age, sex, smoking, alcohol consumption, body mass index, hypertension, diabetes mellitus, dyslipidemia, and microalbuminuria.\u003c/p\u003e\u003cp\u003eThis study has identified a statistically significant association between sex and sensorineural hearing loss (SNHL). The underlying mechanisms likely involve sex-specific differences in hearing preservation and susceptibility to damage. It has been suggested that females may retain better hearing than males following noise exposure and aging, possibly due to the protective role of estrogen in cochlear function \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. This hormone is thought to modulate pathophysiological processes in the inner ear, potentially shielding the auditory system from degeneration.\u003c/p\u003e\u003cp\u003eSimilarly, age exhibited a significant relationship with SNHL, consistent with the natural decline in hearing acuity over time. Age-related hearing loss can be attributed to cumulative noise exposure, ototoxic medication use, cardiovascular risk factors, and the progressive degeneration of cochlear hair cells and auditory nerve fibers \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eOur study demonstrated a significant association between diabetes and sensorineural hearing loss (SNHL). This relationship may be attributed to diabetes-induced macro- and microvascular damage, which can impair cochlear function through multiple mechanisms. Chronic hyperglycemia may lead to reduced blood flow to the inner ear, compromising oxygen delivery and disrupting ion transport in the cochlea's highly vascularized tissues \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Furthermore, diabetic microangiopathy can induce structural changes in the cochlea, including nerve fiber degeneration, demyelination, and potential auditory nerve damage \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. These pathological changes collectively contribute to the development of SNHL in diabetic patients.\u003c/p\u003e\u003cp\u003eThe results revealed a significant association between ear infections and SNHL. This relationship may stem from infection-induced damage to inner ear structures and the auditory nerve. Chronic suppurative otitis media, in particular, has been consistently linked to SNHL in clinical studies \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Such infections can progress beyond the middle ear, potentially damaging cochlear hair cells or disrupting neural transmission pathways. The inflammatory response and bacterial toxins associated with persistent infections may directly impair the delicate sensory structures of the inner ear, leading to permanent hearing loss.\u003c/p\u003e\u003cp\u003eA statistically significant association was observed between chronic noise exposure, particularly in occupational settings, and the development and progression of SNHL, highlighting noise as a major modifiable risk factor \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. This relationship is biologically plausible, as excessive noise exposure causes mechanical and metabolic damage to the cochlea's delicate structures, including the irreversible destruction of hair cells and degeneration of auditory nerve fibers, which are critical for sound transduction \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe main strengths of the current study include the large-scale dataset and strict quality control process, which enhance the generalizability of the findings to a wider population. Furthermore, utilizing data from a cohort study with a large sample size will provide strong statistical power to identify an association between SNHL and CKD. Additionally, the eGFR was measured using a standard kit and instrument by a laboratory expert. Hearing loss was diagnosed with standard instruments by an audiologist, and the hearing evaluations were confirmed by an otolaryngologist. This process increased the validity and accuracy of the findings regarding the relationship between SNHL and CKD. However, certain limitations must also be noted. Due to the cross-sectional design of the present study, causal inferences could not be drawn. Second, information concerning external or middle-ear pathology, congenital hearing loss, and albuminuria, which could potentially confound the association between SNHL and SKD, was not available in our study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThese results demonstrate a clinically significant burden of SNHL in individuals with CKD. The strong independent association between CKD and SNHL, alongside modifiable risk factors like noise exposure and comorbidities such as diabetes, underscores the need for targeted hearing screenings in CKD care pathways\u0026mdash;particularly for high-risk subgroups (e.g., older males with diabetes or occupational noise exposure). While non-modifiable factors like age and sex further refine risk stratification, the absence of links to BMI or education reinforces the importance of prioritizing clinical and environmental predictors. The cross-sectional nature of this study necessitates longitudinal research to establish causality and unravel the pathophysiological interplay between CKD and SNHL. Until then, proactive management of modifiable risks and early auditory monitoring in CKD populations are critical to mitigating this dual health burden.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Participants\u003c/h2\u003e\u003cp\u003eThis population-based cross-sectional study analyzed baseline data from the Hoveyzeh Ear Cohort Study (HEC), a sub-study of the Hoveyzeh Cohort Study designed to evaluate hearing status in adults aged 35\u0026ndash;70 years in southwest Iran \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. All participants underwent comprehensive audiological evaluations, excluding those with chronic neurological disorders, inner ear pathology, otosclerosis, current ototoxic medication use, or history of traumatic brain injury (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAudiology Assessment\u003c/h3\u003e\n\u003cp\u003eAll participants underwent comprehensive audiological evaluations beginning with a detailed case history questionnaire assessing auditory/vestibular symptoms (tinnitus, dizziness, aural fullness, hearing loss), noise exposure history, head trauma, ototoxic drug use, ear surgeries, infections, and systemic diseases (hypertension, diabetes). Middle ear function was evaluated using the AT235 impedance audiometer (Interacoustics, Denmark), while hearing thresholds were measured via pure-tone audiometry in a sound-attenuated booth using a calibrated AD528 clinical audiometer (Interacoustics, Denmark), testing air conduction (250\u0026ndash;8000 Hz) and bone conduction (250\u0026ndash;4000 Hz). Hearing loss severity was classified by pure-tone average (PTA: 500, 1000, 2000, 4000 Hz) as mild (26\u0026ndash;40 dB HL), moderate (41\u0026ndash;55 dB HL), moderate-severe (56\u0026ndash;70 dB HL), severe (71\u0026ndash;90 dB HL), or profound (\u0026gt;\u0026thinsp;90 dB HL) \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eDefinition of covariates\u003c/h2\u003e\u003cp\u003eThe analysis included demographic variables (age groups: 35\u0026ndash;39, 40\u0026ndash;44, 45\u0026ndash;49, 50\u0026ndash;54, 55\u0026ndash;59, 60\u0026ndash;64, and \u0026ge;\u0026thinsp;65 years; sex(male/female); residence type (urban/rural)), education level (illiterate to university), otologic history (ear infections, noise exposure), and health indicators: BMI (underweight\u0026thinsp;\u0026lt;\u0026thinsp;18.5, normal 18.5\u0026ndash;24.9, overweight 25-29.9, obese\u0026thinsp;\u0026ge;\u0026thinsp;30), diabetes (fasting glucose\u0026thinsp;\u0026ge;\u0026thinsp;126 mg/dL, medication use, or self-reported diagnosis), hypertension (BP\u0026thinsp;\u0026ge;\u0026thinsp;140/90 mmHg, antihypertensive use, or self-reported diagnosis), and chronic kidney disease (CKD) defined as eGFR\u0026thinsp;\u0026lt;\u0026thinsp;60 mL/min/1.73 m\u0026sup2; calculated using the Cockcroft-Gault formula: CrCl = [(140-age)\u0026times;weight\u0026times;(0.85 if female)]/(72\u0026times;serum creatinine) \u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eAll analyses were performed using STATA 15 (StataCorp, College Station, TX). Continuous variables were summarized as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), while categorical variables were reported as frequencies and percentages. Initial associations were assessed using chi-square tests (χ\u0026sup2;) and crude odds ratios in univariate analyses. Potential confounders (e.g., age, sex, education level) were adjusted for in multiple logistic regression models, with variables showing p\u0026thinsp;\u0026lt;\u0026thinsp;0.2 in univariate analyses eligible for inclusion. Statistical significance was defined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all final models.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all those involved in this study and the staff who helped in data collection. Also, the Vice-Chancellor for Research at Ahvaz Jundishapur University of Medical Sciences was as funding organizations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the local Ethics Committee (Ethics code:IR.AJUMS.REC.1402.496) and was conducted in accordance with the Helsinki Declaration. On the registration day, informed written consent was obtained from all participants[grant number HRC-0203].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no competing interests related to this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was funded\u0026nbsp;by\u0026nbsp;the Vice-Chancellor for Research at Ahvaz Jundishapur University of Medical Sciences [grant\u0026nbsp;number\u0026nbsp;HRC-0203].\u0026nbsp;The Vice-Chancellor for Research at Ahvaz Jundishapur University of Medical Sciences as our funding body played no role in the design of the study and gathering, analysis, and interpretation of data and in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNader Saki:\u003c/strong\u003e Conceptualization, Writing- Reviewing and Editing. \u003cstrong\u003eZahra Rahimi:\u003c/strong\u003e Conceptualization, Data Curation, Writing- Reviewing and Editing and Formal analysis. \u003cstrong\u003eBahman Cheraghian:\u003c/strong\u003e Methodology, Formal analysis, Writing- Reviewing and Editing.\u0026nbsp;\u003cstrong\u003eArash Bayat:\u003c/strong\u003e Investigation, Writing- Reviewing and Editing.\u0026nbsp;\u003cstrong\u003eAli Ghorbani:\u0026nbsp;\u003c/strong\u003eValidation, Supervision. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUpon request, we can offer onsite access to external researchers to the data analyzed at Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. To do so, Dr. Rahimi should be contacted.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGreenberg, D., Rosenblum, N. D. \u0026amp; Tonelli, M. The multifaceted links between hearing loss and chronic kidney disease. \u003cem\u003eNature Reviews Nephrology\u003c/em\u003e, doi:10.1038/s41581-024-00808-2 (2024).\u003c/li\u003e\n\u003cli\u003eChadha, S., Kamenov, K. \u0026amp; Cieza, A. The world report on hearing, 2021. \u003cem\u003eBulletin of the World Health Organization\u003c/em\u003e \u003cstrong\u003e99\u003c/strong\u003e, 242 (2021).\u003c/li\u003e\n\u003cli\u003eHaile, L. M.\u003cem\u003e et al.\u003c/em\u003e Hearing loss prevalence and years lived with disability, 1990\u0026ndash;2019: findings from the Global Burden of Disease Study 2019. \u003cem\u003eThe Lancet\u003c/em\u003e \u003cstrong\u003e397\u003c/strong\u003e, 996-1009 (2021).\u003c/li\u003e\n\u003cli\u003eWilson, B. S., Tucci, D. L., Merson, M. H. \u0026amp; O\u0026apos;Donoghue, G. 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C. \u0026amp; Hoffman, H. J. Hearing loss: rising prevalence and impact. \u003cem\u003eBulletin of the World Health Organization\u003c/em\u003e \u003cstrong\u003e97\u003c/strong\u003e, 646 (2019).\u003c/li\u003e\n\u003cli\u003eSodhi, J. K., Sarin, V. \u0026amp; Chandey, M. To Study the Effect of Chronic Kidney Disease on Hearing Function of the Patients in a Tertiary Care Centre of North India. (2021).\u003c/li\u003e\n\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":"[email protected]","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":"Sensorineural hearing loss, Chronic kidney disease, Iran","lastPublishedDoi":"10.21203/rs.3.rs-6529557/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6529557/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eChronic kidney disease (CKD) is a significant public health issue associated with multiple complications, including hearing loss. This population-based cross-sectional study, conducted from 2017 to 2021 in southwest Iran, evaluated the relationship between CKD and sensorineural hearing loss (SNHL) among 1,365 participants aged 35\u0026ndash;70 years from the Hoveyzeh ear cohort study. Demographic data, comorbidities (e.g., diabetes, hypertension), CKD status, and hearing information were analyzed. After adjusting for confounders via multiple logistic regression, CKD was significantly associated with SNHL (adjusted OR\u0026thinsp;=\u0026thinsp;2.19; 95% CI: 1.16\u0026ndash;4.13). The prevalence of SNHL in CKD patients was 70.49% (95% CI: 57.94\u0026ndash;80.56). Age, male gender, diabetes, noise exposure, and ear infections were also linked to higher odds of SNHL, while hypertension showed no significant association. These findings highlight CKD as an independent risk factor for SNHL and underscore the importance of monitoring hearing health in CKD patients to address comorbid complications.\u003c/p\u003e","manuscriptTitle":"The relationship between sensorineural hearing loss and chronic kidney disease: Results from a population-based cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-22 10:31:52","doi":"10.21203/rs.3.rs-6529557/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","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":"a1d11280-f26f-4eb0-a7ab-6d8a70da6580","owner":[],"postedDate":"August 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":53528232,"name":"Health sciences/Diseases"},{"id":53528233,"name":"Health sciences/Medical research"},{"id":53528235,"name":"Health sciences/Molecular medicine"},{"id":53528236,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-08-25T07:39:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-22 10:31:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6529557","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6529557","identity":"rs-6529557","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}