The Connections Between Hearing Loss and Chronic Kidney Disease (CKD)
The Centers for Disease Control and Prevention (CDC) estimates that 37 million US adults have chronic kidney disease (CKD)—that’s more than 1 in 7. As many as 9 in 10 adults with CKD do not know they have it, and it often goes undetected and undiagnosed until the disease is well advanced.
Your kidneys filter wastes and excess fluids from your blood, which are then removed in your urine. Chronic kidney disease, also called chronic kidney failure, involves a gradual loss of kidney function, causing excess levels of fluids, electrolytes, and wastes to build up in your body.
People with CKD may also be at risk of developing other health complications, including hearing loss. A growing body of research points to a connection between CKD and hearing loss, highlighting the possible harmful effects of CKD on the hearing system. In fact, the National Kidney Foundation estimates that that 54% of people with moderate kidney disease have some kind of hearing loss.
So, could having CKD indicate the risk of developing hearing loss? Or, similarly, could hearing loss point to a possible issue with the kidneys? Let’s dive deeper to find out more.
What is CKD?
Kidney pain is often mistaken for back pain. Chronic kidney disease symptoms are often nonspecific, but can include nausea, loss of appetite, fatigue/weakness, muscle cramps, and swelling of the feet and ankles.
Your kidneys are responsible for filtering out waste. If they become damaged, waste and fluid can build up in the body. This puts you at a higher risk of having other health problems such as gout, anemia, poor nutritional health, weak bones, hypertension, heart disease, and fluid build-up.
Treatment aims to stop or slow down the progression of CKD by controlling its underlying cause. If left untreated, CKD can lead to kidney failure, and the person affected will need to have dialysis (artificial filtering) or a kidney transplant.
How are CKD and hearing loss connected?
HearingTracker spoke to Victor Bray, MSC, PhD, who is an Associate Professor at Osborne College of Audiology at Salus University and Past-president of the Academy of Doctors of Audiology (ADA), to understand the connections shared between the kidneys and the ears. Dr. Bray has researched and lectured extensively on the topic of hearing loss and its association with chronic illnesses.
Victor Bray, PhD.
“The structure of part of the ears and the kidneys, and also the function of cells in the ears and the kidneys is actually very similar,” explains Bray. “So, if you have something that's affecting one of these organs, it's natural that it would affect other organs that have the same structure and function built into them.”
Another connection is that CKD and hearing loss share common risk factors. Hypertension, diabetes, and advanced age can lead to both kidney disease and hearing loss.
Furthermore, toxins that accumulate in the body during kidney failure can damage tissues and organ systems, including the nerves in the inner ear, leading to hearing loss.
Alport syndrome and hearing loss
Alport syndrome is a rare genetic type of kidney disease that can cause progressive loss of kidney function, hearing loss, and eye abnormalities. It is usually diagnosed in early childhood or adolescence, and it is estimated that less than 200,000 people are living with Alport syndrome in the United States.
People with Alport syndrome also frequently develop sensorineural hearing loss (SNHL), which affects the loudness and clarity of speech. In this case, hearing loss is generally caused by abnormalities of the inner ear during late childhood or early adolescence.
What does research show regarding the connection between CKD and hearing loss?
Researchers have long recognized the relationship between kidney function and hearing loss.
In 2010, a team of researchers from the Universities of Sydney, Melbourne, and Macquarie in Australia conducted a groundbreaking study to examine the relationship between CKD and age-related hearing loss. They found that older adults with moderate CKD have a higher prevalence of hearing loss than those of the same age without the condition.
The researchers examined the medical records of 2,564 people aged 50 or older, including 513 with moderate CKD. More than 54% of those with CKD reported some level of hearing loss, compared to only 28% of those who had hearing loss without CKD. Furthermore, almost 30% of the CKD patients had a severe hearing loss, compared to just 10% of the participants without a kidney issue.
Patients on dialysis are at higher risk of experiencing hearing loss.
Likewise, in a 2019 study, researchers found that CKD patients on dialysis were at higher risk of experiencing hearing loss. Of the patients with CKD, 32% were found to have hearing loss compared to 12% in a control group of participants without CKD. In this study, hearing loss affected all the sounds for loudness and clarity of speech. The losses were in the mild range (less than 40 dB) in both ears and were non-reversible.
A 2020 study also reported similar results. Researchers explored the association between reduced kidney function and hearing loss, finding that patients with reduced kidney function had increased risk of hearing loss.
It’s important to note that these study results do not suggest that kidney disease causes hearing loss, just that there is a link between the two.
CKD and a possible link with Ménière’s disease and sudden sensorineural hearing loss (SSNHL)
There may be a connection between CKD and Ménière’s disease—an inner ear disorder thought to be caused by increased pressure of an abnormally large amount of endolymph (fluid in the inner ear) and/or from the presence of potassium in an area of the inner ear where it doesn’t belong. Symptoms of Ménière’s disease include hearing loss, sudden attacks of vertigo, tinnitus, and the feeling of ear fullness.
Meniere's disease is an inner ear problem that can cause dizzy spells or vertigo, as well as hearing loss and tinnitus.
Those affected by CKD may also have an increased risk of experiencing a sudden sensorineural hearing loss (SSNHL)—a sudden or rapid loss of hearing in one or both ears, which can occur immediately or over a few days.
What the research says about CKD and sudden hearing loss, tinnitus, and balance problems
Though more research is needed to study these relationships, a 2021 study observed that CKD resulted in a significantly increased risk of SSNHL and Ménière’s disease. Interestingly, hearing loss was greater in females than in males.
Why the connection?
Bray suggests one possible explanation for the link between CKD and Ménière’s disease could be in the similarities in the roles of both the kidneys and endolymph in maintaining healthy levels of electrolytes (minerals) in the body. When one of these systems has abnormalities or disease, this could impact the other, and vice versa.
Additionally, Bray explains the connection between CKD and SSNHL could lie in factors such as hypertension and cardiovascular disease, which put you at increased risk for both conditions.
It is important to note that if you think you might be experiencing SSNHL, be sure to seek immediate medical attention, as sudden hearing loss can be an indicator of a serious medical condition and early treatment can help save your hearing.
Can CKD medications cause hearing loss?
If you have CKD, the medication you use to treat it could be ototoxic (i.e., could potentially cause damage to the ear) and may adversely affect hearing.
New Jersey audiologist, Robert M. DiSogra, AuD, who writes and lectures on a variety of hearing loss topics and is an expert on ototoxicity explains, “Medications such as loop diuretics and aminoglycoside antibiotics used in the treatment of CKD are known to cause hearing loss.”
Robert DiSogra, AuD.
Similarly, medications such as aminoglycoside antibiotics can also have a damaging effect on the kidney. “Because the ear and the kidney have some very similar structure and function, aminoglycosides are ototoxic to the ear, but they're also nephrotoxic—meaning they could potentially have a damaging effect to the kidney,” says Bray.
Nevertheless, when treating CKD “you’ve got to preserve whole body health,” notes Bray, “though sometimes there are consequences.”
A note on dietary supplements for CKD
Dietary supplement manufacturers are not required to provide safety and efficacy data on their products to the FDA, and the use of supplements for CKD could have serious consequences. In fact, DiSogra warns that many herbs commonly found in traditional medicines may even cause acute kidney injury.
A detailed review of nutrition supplements used in chronic kidney diseases found little evidence of the benefits of these nutrition supplements on CKD prognosis, though there was no evidence of any auditory or vestibular side effects.
While you should follow your doctor's recommendations for improving overall health, there are some medications for CDK that put you at risk for hearing loss.
There clearly needs to be more research to verify the benefits of nutrition supplements in CKD patients and to establish whether there is an associated risk of ototoxicity.
DiSogra summarizes, “There are no dietary supplements approved by the US Food and Drug Administration (FDA) for the management of chronic kidney disease. Patients are advised to discuss this option with their nephrologist (medical doctors who specialize in kidney care) before using a dietary supplement for CKD.”
How to reduce the risk of hearing loss and kidney problems?
To lower your chances of developing kidney problems, the National Kidney Foundation recommends engaging in the 7 Golden Rules of Prevention as follows:
- Talk to your doctor about having urine and blood tests to check how well your kidneys are working to remove waste from your body.
- Control your blood pressure: High blood pressure can increase the risk of kidney disease.
- Manage your blood sugar: Over time, high blood sugar levels can put you at risk of kidney damage.
- Eat a healthy diet.
- Carry out regular exercise.
- Quit smoking: Smoking can cause disease in every organ of the body, including the kidneys.
- Don't overuse pain medicines (particularly non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen) as long-term use can harm kidney tissue.
Engaging in these healthy habits will not only help keep your kidneys healthy but will also help to preserve hearing.
Overall healthy habits, including good eating and exercise habits, can help people fight CKD and hearing loss.
Additionally, to prevent noise-induced hearing loss, Centers for Disease Control and Prevention (CDC) recommend being mindful about how long you spend in environments with loud noise. For prolonged exposure such as concerts or noisy work environments, be sure to wear hearing protection such as ear plugs or earmuffs.
Bray’s advice for patients with CKD is, “Follow your treatment plan (especially pay attention to the high blood pressure) and monitor your hearing status.”
Furthermore, Bray stresses the importance of patients being aware of the possible connection between CKD and hearing loss. “The patient should be aware too— if their physician or their treatment team is not bringing it up, they should self-advocate and get their hearing monitored.”
Why is it important to know about the connection between CKD and hearing loss?
Since there are strong links between CKD and hearing loss, if you have one of these conditions, there’s a possibility you could also have the other.
Because of this, if you have CKD, it may be useful to have your ears checked regularly, so you can take early steps to preserve your hearing. And, similarly, if you are experiencing hearing loss, be sure to have your doctor check your kidney function.
For both conditions, early intervention is key. The earlier CKD is diagnosed, the sooner you can begin treatment to slow down the progression of the disease.
Hearing loss can negatively impact social, psychological, and emotional well-being. The earlier you are fitted with hearing aids or implants to treat hearing loss, the better the chance for a positive outcome and the sooner you can improve your social interactions and quality of life.