Audiological Profile of Patients with Chronic Kidney Disease Undergoing Hemodialysis Using Pure-tone Audiometry and Distortion Product Otoacoustic Emissions: A Cross-sectional Observational Analysis

Background: Chronic kidney disease (CKD) is a major global health problem in which impaired renal clearance leads to accumulation of metabolic toxins, adversely affecting multiple organs, including the auditory system, and contributing to hearing loss. This study evaluated the diagnostic value of distortion product otoacoustic emission (DPOAE) in patients undergoing hemodialysis and compared their sensitivity with pure-tone audiometry (PTA). Materials and Methods: This cross-sectional observational study included 70 adult patients (aged 25–65 years) diagnosed with Stage 5 CKD and undergoing regular hemodialysis for at least 6 months. Detailed otological history, clinical examination, DPOAE, and PTA were conducted. Associations between DPOAE findings, PTA results, dialysis duration, and serum creatinine were analyzed using Chi-square and Pearson correlation tests, with P < 0.05 considered statistically significant. Results: Seventy patients with end-stage renal disease on maintenance hemodialysis (42 males, 28 females; mean age: 52.4 ± 9.8 years) were evaluated. Out of 70 participants, 70% exhibited some degree of hearing loss, predominantly sensorineural (91.8%), bilateral (90.2%), and affecting high frequencies, particularly at 4 and 8 kHz. DPOAEs detected cochlear dysfunction in 80% (56/70) of patients, identifying subclinical hearing loss in 12% (8/70) who had normal PTA thresholds. Hearing thresholds showed a strong positive correlation with duration of hemodialysis ( r = 0.65, P < 0.001) and serum creatinine levels ( r = 0.55, P < 0.001), indicating worsening auditory function with increasing renal disease severity. Conclusion: DPOAEs were more sensitive than PTA in detecting early cochlear dysfunction in hemodialysis patients, with hearing loss strongly associated with longer dialysis duration and higher serum creatinine levels.