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Review Article
74 (
1
); 32-39
doi:
10.25259/IJMS_135_2021

The effect of hemodialysis on hearing in chronic kidney disease patients – A systematic review

Department of Otorhinolaryngology, International Medical School, Management and Science University, Shah Alam, Selangor, Malaysia
Department of Biochemistry, International Medical School, Management and Science University, Shah Alam, Selangor, Malaysia
Corresponding author: Kavitha Ashok Kumar, Department of Otorhinolaryngology, International Medical School, Management and Science University, Shah Alam, Selangor, Malaysia. drkavithaent@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Kumar KA, Hishamudin AD, Krishnan DA, Lingam H, Manogaran JA, Yahya NA, et al. The effect of hemodialysis on hearing in chronic kidney disease patients – A systematic review. Indian J Med Sci 2022;74:32-9.

Abstract

Hemodialysis as a treatment modality for Stage V chronic kidney disease (CKD) has significantly decreased mortality. However, there have been several studies reporting sensorineural hearing loss (SNHL) in these patients which affects their quality of life. The role of hemodialysis in its etiology has been widely debated and the strength of available evidence has not yet been evaluated. A systematic literature review was conducted to identify a possible association of hemodialysis to hearing loss and guide in making informed decisions in the management of CKD patients. Relevant articles from PubMed, ScienceDirect, EBSCO Medline, SCOPUS, Google Scholar, and Clinical Key were identified using Preferred Reporting Items for Systematic Review and Meta-Analyses framework. Studies that were published since the inception of the database to May 2020 and written in the English language were analyzed. A total of 36 articles on hemodialysis and sudden or SNHL were retrieved. Many were observational (13 cohorts, 10 case-control, seven case series, and six cross-sectional) studies involving 99,020 participants with ages ranging from 1 to 80 years. This review elucidates the occurrence of SNHL in CKD patients on hemodialysis. Yet, the available literature fails to provide conclusive evidence on hemodialysis as a causative agent for SNHL. Audiological assessment of all CKD patients before hemodialysis and regular follow-up may help in early diagnosis and better management of hearing loss.

Keywords

Hemodialysis
Sensorineural hearing loss
Sudden hearing loss
Sudden deafness
Chronic kidney disease patients

INTRODUCTION

Chronic kidney disease (CKD) is a multisystem disorder characterized by a gradual impairment of kidney function culminating in chronic kidney failure which is now termed as Stage V CKD characterized by glomerular filtration rate below 15 ml/min/1.73 m2 and reduction in creatinine clearance of 10 ml/min/1.73 m2.[1] It is one of the leading causes of mortality and morbidity in the elderly. According to health statistics, the global prevalence of CKD in 2017 was 9.1% of the population (697.5 million cases).[2] The all-age global prevalence of CKD increased by 29.3% between 1990 and 2017.[2] An aging population worldwide may account for this upswing. CKD patients require renal replacement therapy in the form of either renal transplantation, peritoneal dialysis, or hemodialysis as treatment.[3]

Willem Kolff from the Netherlands pioneered modern hemodialysis therapy in 1943.[4] Hemodialysis is the process of the removal of unwanted substances and extra fluid from the blood using a dialyzer. It is a complex life support system that has helped reduce mortality from CRF.[5] The all-age and age-standardized global incidence of dialysis have increased between 1990 and 2017 by 43.1% and 10.7%, respectively.[2] However, there have been many reports of CKD patients developing complications such as cardiovascular accidents, infection, protein anabolism, anorexia, fatigue, breathlessness, as well as sensorineural hearing loss (SNHL) which compromise the quality of life of these patients.[5,6] Any pathology in the cochlea, vestibular cochlear nerve, or central auditory pathways can lead to SNHL.[7] A SNHL of more than 30 dB at three sequential frequencies occurring within a period of 72 h is called sudden SNHL (SSNHL).[8]

Hemodialysis is a long-term treatment that is quite expensive. Hence, the quality of life a patient enjoys is the key yardstick to measure its effectiveness in addition to its role in maintaining homeostasis. According to a recent study by Li (2020), approximately 30–40% of patients under regular hemodialysis experienced SNHL.[9] Although numerous studies documented hearing loss in renal failure patients on hemodialysis, the exact cause for this hearing loss remains controversial.[10,11] It is not clear whether the hearing loss reported in CKD patients is due to the disease process or due to the intervention. A recent study showed that there was an increased risk of mortality with atherosclerotic complications in hemodialysis patients with new-onset SNHL.[12] As the number of CKD patients is increasing at an alarming rate, the number of people requiring hemodialysis is bound to increase. This systematic review makes an effort to answer the research question “Does Hemodialysis cause sensorineural hearing loss?

MATERIAL AND METHODS

This systematic review was conducted using Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) framework.[13] All primary articles relevant to the research question were searched from the available literature.

Search strategy

The search engines used to extract the data were PubMed, Science Direct, SCOPUS, Clinical key, EBSCO Medline, and Google Scholar. The electronic search was performed using different combinations of the terms, namely, hemodialysis, SNHL, sudden hearing loss, sudden deafness, chronic renal disease, CKD, and chronic renal failure. All the literature available from database inception till May 31, 2020, was included in the study. The selected articles were exported to Mendeley (Desktop version 1.19.4). These records were screened for duplication, by titles and abstracts, inclusion-exclusion criteria, and availability of full text. The entire process of screening and reviewing the full texts of eligible articles was done independently by two groups of three authors.

Inclusion criteria

This study attempted to investigate the association of SNHL and hemodialysis in CKD patients. The experimental studies, as well as observational studies such as case reports, cross-sectional studies, case–control studies, and cohort studies (prospective and retrospective), were included as the source of data. The inclusion and exclusion criteria were clearly defined. The articles needed to be in the English language. The study population was CKD patients. The intervention should be hemodialysis. Comparators included were CKD patients on other treatment modalities such as conservative treatment, peritoneal dialysis, and renal transplantation or age- and sex-matched healthy controls. The outcome observed in all the incorporated studies was the development of SNHL or SSNHL. Confirmed hearing loss with either pure tone audiometry (PTA), distortion product otoacoustic emissions (DPOAE), transitory evoked otoacoustic emission (TEOAE), or impedance audiometry was included in the study. The WHO classification or ASHA classification used to quantify the degree of hearing loss was reported in this study.[14]

Exclusion criteria

Studies on CKD patients who had undergone hemodialysis but developed complications other than hearing loss were excluded from the study. Besides, patients with conductive hearing impairment or having known causes for hearing loss such as ototoxic drug intake and noise exposure were also eliminated from this review.

Quality assessment

The studies with keywords in the title and abstract were selected, full text retrieved, and critically appraised independently by two groups of three authors to assess for its relevance, validity, and potential risk of bias using the Critical Appraisal Skills Programme Checklist (CASP). Separate checklists were used for case-control and cohort studies.[15]

Data extraction

In the included studies, several characteristics such as publication year, the country where the study was conducted, study design, the target population (age and gender distribution), type of treatment for Stage V CKD (hemodialysis, peritoneal dialysis, renal transplantation, or conservative treatment), duration of hemodialysis, duration of follow-up, and criteria to evaluate hearing levels were extracted. The results of the study were appraised for the quality of evidence and bias if any were reported.

Statistical analysis

Descriptive analysis was done and the characteristics of individual studies were compiled in a tabular form.

RESULTS

Search results

This systematic review was guided by the PRISMA framework [Figure 1]. A total of 1584 articles were retrieved and imported to Mendeley to be reviewed independently by two groups of three authors. One hundred and thirty-eight duplicates were removed. On screening for relevance with the titles and abstracts, 1265 articles were excluded (1195 articles were irrelevant, 49 articles were not in the English language, and 21 articles were not available in full text). A total of 181 full-text eligible articles were screened based on inclusion/ exclusion criteria and 145 articles were eliminated as the CKD patients had exposure to one or more factors that could also cause hearing loss such as radiation, noise, ototoxic drugs, Alport syndrome, or Fabry’s disease. Finally, 36 scientific articles were included for qualitative synthesis. The 36 articles extracted were from 1973 to 2020 and came from 16 different countries. The details are shown in [Table 1].

Figure 1:: Preferred Reporting Items for Systematic Review and Meta-Analyses flowchart.
Table 1:: Characteristics of included studies.
No. Author Year Study design Sample size (n) Duration of hemodialysis (in years) Comparators Hearing assessment employed Correlation of hemodialysis with hearing loss
1 Saeeda 2018 Cohort (prospective) 59 1 None PTA There is a significant correlation
2 Mancini et al. 1996 Cross sectional 68 8.75 Conservative and renal transplant PTA, impedance audiometry There is a significant correlation
3 Singh et al. 2018 Case control 55 >1/12 Conservative PTA, TEOAE There is a significant correlation
4 Fidan et al. 2012 Cohort (prospective) 119 Unspecified Peritoneal dialysis and healthy control PTA, TEOAE There is a significant correlation
5 Kusakari et al. 1992 Case control 37 8.75 None PTA There is no significant correlation
6 Ozturan and Lam 1998 Cohort (prospective) 19 7 Healthy control PTA, DPOAE There is no significant correlation
7 Okwuonu et al. 2017 Case report 1 Unspecified None PTA There is a significant correlation
8 Saha et al. 2020 Case control 1000 5 Healthy control PTA There is a significant correlation
9 Jakić et al. 2010 Case report 66 30 None PTA There is a significant correlation
10 Sam 2014 Cross sectional 119 2 Conservative and healthy control PTA There is a significant correlation
11 Wang et al. 2017 Cohort (retrospective) 95,425 0.4 Healthy control PTA There is a significant correlation
12 Mwangi 2012 Case control 78 4/52 Conservative PTA There is no significant correlation
13 Jamaldeen et al. 2015 Case control 120 Unspecified Healthy control PTA There is a significant correlation
14 Reshma et al. 2017 Cross sectional 60 Unspecified Healthy control PTA There is no significant correlation
15 Makita et al. 1995 Case report 6 5 None PTA There is a significant correlation
16 Akeem O. Lasisi 2007 Case report 61 Unspecified Healthy control PTA There is a significant correlation
17 Lavonne Rergsthom 1973 Case report 224 Unspecified None PTA There is no significant correlation
18 Cedric A. Quick 1976 Case report 602 7 None PTA There is no significant correlation
19 M.M. Ghasemi 2004 Case control 62 18 Conservative and control PTA, impedance audiometry There is no significant correlation
20 D. Gatland 1991 Cohort (prospective) 66 Unspecified None PTA There is no significant correlation
21 Syed S. Rizvi 1980 Case report 1 Unspecified None PTA There is a significant correlation
22 A. Barbara Klingerman 1981 Cohort (prospective) 67 1 Healthy control PTA, tympanometry There is no significant correlation
23 Joseph O. Boateng 2019 Case control 100 Unspecified Healthy control PTA, tympanometry There is a significant correlation
24 P. Stavroulaki 2001 Cohort (prospective) 18 8.75 Healthy control PTA, DPOAE There is no significant correlation
25 Bendo et al. 2015 Cohort (prospective) 61 1 Conservative and control PTA, DPOAE There is a significant correlation
26 Lent 2001 Cohort (prospective) 19 5.6 None PTA There is no significant correlation
27 Lasisi et al. 2006 Case control 61 10 Healthy controls PTA There is a significant correlation
28 William 1977 Cohort (prospective) 20 Unspecified None PTA There is a significant correlation
29 Nikolopoulos et al. 1997 Cohort (prospective) 46 Unspecified None PTA There is no significant correlation
30 Bendo et al. 2015 Case control 53 Unspecified Healthy control PTA, impedance audiometry, DPOAE There is no significant correlation
31 Aspris et al. 2008 Cohort (prospective) 62 24 Healthy control PTA There is no significant correlation
32 Li et al. 2020 Cross sectional 26 21.67 None PTA There is a significant correlation
33 Gabr et al. 2019 Cross sectional 60 Unspecified Conservative and control PTA, DPOAE, TEOAE There is a significant correlation
34 El-Anwar 2013 Case control 30 >2 Healthy control PTA, TEOAE There is a significant correlation
35 Singh et al. 2016 Cohort (prospective) 50 2 None PTA, DPOAE There is a significant correlation
36 Esfahani 2004 Cross sectional 30 1 None PTA There is no significant correlation

Study population

The study population comprised 99,020 individuals (43,143 males and 55,877 females). Their ages ranged from 1 year to 80 years. Among them, 21,787 were CKD patients while 77,233 were healthy controls. Among the CKD patients, the mean duration of the disease was 5 years.[9,10,16-35] The different treatment modalities for CKD reported were hemodialysis in 15,007 and peritoneal dialysis in 6443 while 195 were on conservative treatment and 142 participants had undergone renal transplantation.

Audiological tests used

It was observed that different researchers used varied audiological tests to detect and quantify the hearing loss. The most common being PTA used in 61.1% of the studies as a single assessment tool while it was combined with DPOAE in four studies,[22,24,33,36] with TEOAE in three studies[23,32,37] while all three hearing assessment tools; PTA, DPOAE, and TEOAE were used in one.[38] In two studies, impedance audiometry was used along with PTA,[20,30] while in one study, impedance audiometry was used with PTA and DPOAE.[25] Speech audiometry was used along with PTA in one study.[7] A single study incorporated Brainstem Evoked Response Audiometry (BERA) as a hearing assessment tool.[38]

Study design

The varying study design was encountered in this systematic review with 13 cohort studies, 10 case-control studies, seven case reports, and six cross-sectional studies [Figure 2]. Among the cohort studies, there were 12 prospective studies and one retrospective study with a total of 96,040 participants. Cohort studies on this topic from 1977[40] to 2018[27] were obtained. There are conflicting results with six articles[24,27,35,37,40] reporting hemodialysis as the cause for the development of SNHL while the remainder refuted it.[21,22,29,33,41,43]

Figure 2:: Distribution of the study design employed.

The earliest case-control study on this topic was in 1992[10] while the most recent was in 2020.[16] The total sample from case-control studies was 1656. Case-control studies helped to compare the audiological results of the target population (patients on hemodialysis) with healthy, age- and gender-matched controls[10,16,20,23,25,28,44,45] or with CKD patients receiving conservative treatment.[17,20,32] Six among them reported a positive association between hemodialysis and occurrence of SNHL,[16,23,28,32,44,45] while four were unable to demonstrate a clear association of SNHL and hemodialysis.[10,17,20,25]

Case reports constituted a total sample of 962. The earliest case report dates back to 1973[47] while the latest was in 2017.[6] The majority of these articles demonstrated a significant association between hemodialysis and SSNHL.[6,18,26,28,46,48]

Cross-sectional studies formed 16.7% of the selected articles from 1996[30] to 2020[9] with a sample population of 363. Similar to case reports, cross-sectional studies linked hemodialysis to the occurrence of SSNHL.[9,30,34,38,49]

Hemodialysis and hearing loss

High-frequency SNHL was reported in 89% of the studies while 11% did not specify the frequency affected. The time period of hemodialysis was mentioned in only 63.9% of studies with the mean duration of hemodialysis being 5.6 years. Although all studies reported the occurrence of SNHL, only 22% of studies reported an association of hearing loss with the duration of dialysis.[17,27,28,35,37,44,46] The follow-up period after hemodialysis varied from 3 months to 12 years. About 5.5% of participants reported SNHL after the very first session of hemodialysis.[24,28] Pre-dialysis hearing assessment to detect any pre-existing hearing impairment was mentioned in only 13 (38%) of the 36 studies.[16,19,22,24,27,28,33,36,37,40,43,44,46]

DISCUSSION

Case reports linking hemodialysis to the occurrence of SNHL in CKD patients have existed for a significant period of time. Since 1973, there have been several published articles that referred to this topic without drawing any conclusion on the specific cause for the hearing loss.[7] This systematic review comprehensively encapsulated the published evidence on the association of hemodialysis with SNHL in CKD patients. In the present review of 36 articles on the topic, numerous variations were encountered concerning the methodologic design employed, the patient population selected, the duration of hemodialysis, duration of follow-up after hemodialysis, and the methods used for the assessment of hearing loss. Many were observational studies such as cohort studies, case-control studies, case reports, case series, and cross-sectional studies which are placed at a lower level at the hierarchy of evidence-based medicine.[50] Researchers seemed to prefer prospective over retrospective studies to minimalize bias and for better precision in determining the association of the intervention to the outcome. Selection bias was manifested by a few studies which focused on one specific group, namely, the younger age group[22,51] or patients already undergoing hemodialysis in the hospital for a varied duration.[19,33] Absence of homogeneity in the study population in the various studies limited the generalizability of the results to represent a wider population. In this systematic review, 22 out of 36 studies documented an association between hemodialysis and SNHL. Majority of the case studies and cross-sectional studies reported a positive correlation. Similarly, six out of 10 case-control studies confirmed a positive association of hemodialysis with SNHL when compared to the control group. The 13 cohort studies served as the focal point of this systematic review as they contributed to the largest sample population and allowed evaluation of the relationship of intervention to an outcome.

Six of these studies too reported a positive association between SNHL and hemodialysis. It proved to be a reliable provider of relevant data due to a lack of randomized controlled trials. These findings show that hemodialysis has a significant role in the causation of SNHL.

Although the majority of the studies reported SNHL in CKD patients on hemodialysis, some degree of ambiguity regarding its etiology was revealed by this review. The key to understanding this unique complication of SNHL in CKD patients may lie in the basic anatomical and physiological properties of the kidney and cochlea. Literature states that the underlying mechanism responsible for SSNHL in CKD patients may be fundamentally due to the stria vascularis of the cochlea and basement membrane of the kidney glomeruli functioning primarily through the Na+-K+-activated ATPase. Although the underlying mechanism is not known, the hypothesis suggested that the cochlea is vulnerable to changes in electrolyte concentration and osmolality which may, in turn, result in loss of hair cells, the collapse of endolymphatic space, edema, and atrophy of specialized auditory cells leading to SNHL.[16,51] Reshma et al. in their study on patients with CKD on hemodialysis related the occurrence of SNHL to decreased total antioxidant capacity and increased oxidative stress.[52] On the other hand, some other researchers claim that the uremia, anemia, and osmotic alteration brought about hemodialysis were to be blamed for the development of SNHL.[48]

CONCLUSION

The data collected for this literature review from a pool of studies elucidate that hemodialysis may have a pivotal role in the mechanism of SNHL in CRF patients. However, there is a lack of concrete evidence indicating hemodialysis as the sole cause for SNHL. Therefore, routine otological examination with audiological assessment of CRF patients before hemodialysis is recommended. Further research on this topic with longitudinal study design, well-defined study population, and objective measurements is suggested to draw a valid conclusion on the causal effect of hemodialysis to SNHL in CRF patients.

Recommendations of the study

All CRF patients need to undergo thorough pre-hemodialysis otologic and audiometric evaluation followed by repeated audiological assessments at regular intervals of hemodialysis to identify patients who may develop hearing impairment during treatment. This may prove to be the stepping stone in early detection as well as lead to a better understanding of the etiology of SSNHL in patients on hemodialysis. Further, a randomized controlled trial on this topic would help provide a stronger level of evidence to expand scientific knowledge and contribute to making conclusions about the effect of hemodialysis on hearing.

Limitations of the study

Inability to access some of the full-text articles might have affected this literature review.

Acknowledgment

The authors are grateful to the institution for providing the resources to conduct this review.

Declaration of patient consent

Patient consent is not required as there are no patients in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , . Chronic renal failure In: Stat Pearls. Treasure Island, FL: Stat Pearls Publishing; .
    [Google Scholar]
  2. , , , , , , et al. Global, regional, and national burden of chronic kidney disease, 1990-2017: A systematic analysis for the global burden of disease study 2017. Lancet. 2020;395:709-33.
    [CrossRef] [Google Scholar]
  3. , , . Preference-based quality of life of patients on renal replacement therapy: A systematic review and meta-analysis. Value Health. 2008;11:733-41.
    [CrossRef] [PubMed] [Google Scholar]
  4. . History of vascular access for haemodialysis. Nephrol Dial Transplant. 2005;20:2629-35.
    [CrossRef] [PubMed] [Google Scholar]
  5. , . Haemodialysis. Lancet. 1999;353:737-42.
    [CrossRef] [Google Scholar]
  6. , , . Sudden profound sensorineural hearing loss following initiation of haemodialysis in a patient with end-stage renal disease. Int J Med Biomed Res. 2017;6:30-8.
    [CrossRef] [Google Scholar]
  7. , . Acute and chronic tonsilitis In: Diseases of Ear. Nose and Throat and Head and Neck Surgery. India: Elsevier; . p. 257-71.
    [Google Scholar]
  8. , , . Idiopathic sudden sensorineural hearing loss in dialysis patients. Ren Fail. 2018;40:170-4.
    [CrossRef] [PubMed] [Google Scholar]
  9. , , . Acute sensorineural hearing loss in hemodialysis patients. Acta Otolaryngol. 2020;140:570-4.
    [CrossRef] [PubMed] [Google Scholar]
  10. , , , , . The hearing of the patients treated with hemodialysis: A long term follow-up study. Auris Nasus Larynx. 1992;19:105-13.
    [CrossRef] [Google Scholar]
  11. , , , , . Sensorineural hearing loss in chronic kidney disease-outcome of the trial of steroid therapy. Trop J Nephrol. 2009;4:37-9. Available from: http://www.tjn-online.com/index.php/tjn/article/view/93 [Last accessed on 2020 Jul 03]
    [Google Scholar]
  12. , , , . Sudden sensorineural hearing loss in hemodialysis patients could be a marker of pathogenic progression in the mortality and atherosclerotic events: A national cohort study. Otol Neurotol. 2018;39:1241-9.
    [CrossRef] [PubMed] [Google Scholar]
  13. , , , , , , et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Med. 2009;6:e1000100.
    [CrossRef] [PubMed] [Google Scholar]
  14. , , . Classification of hearing loss In: Update on Hearing Loss. Vol 4. Norderstedt, Germany: BoD-Books on Demand; . p. :29-37.
    [CrossRef] [Google Scholar]
  15. . CASP Checklist: Cohort Study. . UK: CASP; 7. Available from: http://www.casp-uk.net [Last accessed on 2020 Jul 03]
    [Google Scholar]
  16. , . Study of prevalence and pattern of senserineural hearing impairment in stage 5 chronic kidney disease patients on haemodialysis-at a tertiary health care setup in India. Int J Curr Res Rev. 2020;12:8-13.
    [CrossRef] [Google Scholar]
  17. . Prevalence of Hearing Loss in Patients with Chronic Renal Failure and Effect of Haemodialysis on Hearing in Kenyaita National Hospital Kenya: University of Nairobi; . p. 1-48.
    [Google Scholar]
  18. , , , , . Idiopathic sudden sensorineural hearing loss in patients undergoing long-term haemodialysis. Int Urol Nephro. 1995;27:487-93.
    [CrossRef] [PubMed] [Google Scholar]
  19. . Hearing loss in patients with dialysis and renal transplants. Ann Otol Rhinol Laryngol. 1976;85:776-90.
    [CrossRef] [PubMed] [Google Scholar]
  20. , , . Hearing loss in hemodialysis patients. Med J Islam Repub Iran. 2004;17:293-6.
    [Google Scholar]
  21. , , , , . Hearing impairment associated with chronic renal failure. Laryngoscope. 1981;91:583-92.
    [CrossRef] [PubMed] [Google Scholar]
  22. , , , . Hearing evaluation with distortion-product otoacoustic emissions in young patients undergoing haemodialysis. Clin Otolaryngol Allied Sci. 2001;26:235-42.
    [CrossRef] [PubMed] [Google Scholar]
  23. . Audiological findings in children with chronic renal failure on regular hemodialysis. Egypt J Otolaryngol. 2013;29:182. Available from: http://www.ejo.eg.net/article.asp?issn=1012-5574;year=2013;volume=29;issue=3;spage=182;epage=188;aulast=el-anwar [Last accessed on 2020 Jul 03]
    [Google Scholar]
  24. , , , . A study to predict hearing loss in patients undergoing hemodialysis by using DPOAE. Int J Res Rev. 2016;3:18. Available from: http://www.ijrrjournal.com [Last accessed on 2020 Jul 03]
    [Google Scholar]
  25. , , . DPOAE measurements in comparison to audiometric measurements in hemodialyzed patients. J Acute Dis. 2015;4:226-9.
    [CrossRef] [Google Scholar]
  26. , , , , . Sensorineural hearing loss in hemodialysis patients. Coll Antropol. 2010;34:165-71.
    [Google Scholar]
  27. , , , . Sensorineural hearing loss in patients with chronic renal failure on hemodialysis in Basrah, Iraq. Tzu Chi Med J. 2018;30:216-20.
    [CrossRef] [PubMed] [Google Scholar]
  28. , , , , . Effect of hemodialysis on the hearing function of patients with chronic renal failure. Afr J Health Sci. 2006;13:29-32.
    [CrossRef] [Google Scholar]
  29. , , , , , . Auditory brainstem responses in patients under treatment of hemodialysis. Ren Fail. 2008;30:383-90.
    [CrossRef] [PubMed] [Google Scholar]
  30. , , , , . Sensorineural hearing loss in patients reaching chronic renal failure in childhood. Pediatr Nephrol. 1996;10:38-40. Available from: https://www.link.springer.com/article [Last accessed on 2020 Jul 03]
    [CrossRef] [PubMed] [Google Scholar]
  31. , , , , , , et al. Rare causes of unilateral sensorineural hearing loss in adults: Our experience. Indian J Otolaryngol Head Neck Surg. 2020;72:428-36.
    [CrossRef] [PubMed] [Google Scholar]
  32. , , , . To study auditory functions in chronic kidney disease. Indian J Otol. 2018;23:261-5.
    [Google Scholar]
  33. , . The effect of hemodialysis on hearing using pure-tone audiometry and distortion-product otoacoustic emissions. ORL J Otorhinolaryngol Relat Spec. 1998;60:306-13.
    [CrossRef] [PubMed] [Google Scholar]
  34. , , , . Hearing impairment in patients with chronic renal failure. J Med Sci Clin Res. 2014;2:406-16.
    [Google Scholar]
  35. , , , , . Risk of sudden sensorineural hearing loss in patients with end-stage renal disease undergoing dialysis. Nephrology. 2017;22:397-402.
    [CrossRef] [PubMed] [Google Scholar]
  36. , , . Hearing evaluation in patients with chronic renal failure. J Acute Dis. 2015;4:51-3.
    [CrossRef] [Google Scholar]
  37. , , . The prevalence of hearing loss in dialysis patients. Acta Acust United Acust. 2012;98:800-3.
    [CrossRef] [Google Scholar]
  38. , , . Audiovestibular functions in chronic kidney disease in relation to haemodialysis. J Laryngol Otol. 2019;133:592-9.
    [CrossRef] [PubMed] [Google Scholar]
  39. , , , . Auditory brain stem response and otoacoustic emission results in children with end-stage renal disease. Int J Pediatr Otorhinolaryngol. 2011;75:704-7.
    [CrossRef] [PubMed] [Google Scholar]
  40. , , , . Effect of dialysis on hearing acuity. Nephron. 1977;18:348-51.
    [CrossRef] [PubMed] [Google Scholar]
  41. , , , , . Hearing loss in chronic renal failure-hearing threshold changes following haemodialysis. J R Soc Med. 1991;84:587-9.
    [Google Scholar]
  42. , , , , , , et al. Auditory function in young patients with chronic renal failure. Clin Otolaryngol Allied Sci. 1997;22:222-5.
    [CrossRef] [PubMed] [Google Scholar]
  43. , , . Effects of a single session of hemodialysis on hearing abilities. Acta Otolaryngol. 2001;121:836-8.
    [CrossRef] [PubMed] [Google Scholar]
  44. , , , . Prevalence and patterns of hearing loss among chronic kidney disease patients undergoing haemodialysis. Australas Med J. 2015;8:41-6.
    [CrossRef] [PubMed] [Google Scholar]
  45. , , , . Hearing impairment among chronic kidney disease patients on haemodialysis at a tertiary hospital in Ghana. Ghana Med J. 2019;53:197-203.
    [CrossRef] [PubMed] [Google Scholar]
  46. , , , , , . Sensorineural Hearing loss in children with end-stage renal disease. Acta Med Iran. 2004;42:375-8.
    [Google Scholar]
  47. , , , . Hearing loss in renal disease: Clinical and pathological studies. Ann Otol Rhinol Laryngol. 1973;82:555-76.
    [CrossRef] [PubMed] [Google Scholar]
  48. , . Hearing loss from hemodialysis. Arch Otolaryngol. 1980;106:751-6.
    [CrossRef] [PubMed] [Google Scholar]
  49. , , , . Evaluating the prevalence of sensorineural hearing loss in chronic renal failure patients undergoing hemodialysis in Imam Khomeini Hospital, Ahvaz, 2012-2014. Biosci Biotechnol Res Asia. 2015;12:91-6.
    [CrossRef] [Google Scholar]
  50. , , , . New evidence pyramid. Evid Based Med. 2016;21:125-7.
    [CrossRef] [PubMed] [Google Scholar]
  51. , . Hearing evaluation in patients with chronic renal failure: A 1 year cross-sectional study in a tertiary care centre. Indian J Otolaryngol Head Neck Surg. 2019;71:1633-8.
    [CrossRef] [PubMed] [Google Scholar]
  52. , , , , , . Oxidative stress markers in chronic kidney disease patients with hearing loss. Int J Biomed Res. 2017;8:259-62.
    [Google Scholar]
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