Not clearly: chronic kidney disease is linked to more hearing loss, but studies disagree about tinnitus. Taiwanese insurance records suggest a threefold risk after adjustment, while a US national survey found no clear link once age was taken into account.
The picture is sharper in two places. People on dialysis carry the strongest signal in the data that exist, and loop diuretics such as furosemide become more of a risk to the ear when kidney function is severely reduced.
Hearing loss: the firmer link
A 2026 meta-analysis in the Brazilian Journal of Otorhinolaryngology pooled ten studies covering 1,392,700 people and found chronic kidney disease (CKD) associated with hearing loss at an odds ratio of 1.50 (95% CI 1.13–1.98), roughly 50% higher odds. The studies disagreed a great deal about the size of the effect (I² = 94.8%), although removing any single study did not overturn the result. The cross-sectional studies gave a smaller figure of 1.28 (95% CI 1.17–1.41).
A US national sample points the same way. An analysis of 5,131 adults in the National Health and Nutrition Examination Survey (NHANES) 2015–2018, where kidney disease was identified from blood and urine tests, found CKD linked to self-reported hearing loss after adjusting for age, sex, race, education, marital status, income, weight, smoking, depression and cardiovascular disease (odds ratio 1.31, 95% CI 1.1–1.55).
On dialysis, hearing loss is common. Of 838 adults on maintenance haemodialysis tested at seven centres in Shanghai and Suzhou, 423, or 50.5%, had mild to profound hearing loss on a pure-tone audiogram. Their average age was 61 and the study had no comparison group, so it cannot say how much of that figure reflects age rather than kidney disease.
This matters because most tinnitus accompanies sensorineural hearing loss, as the Taiwanese researchers below note; tinnitus and hearing loss covers that connection.
Tinnitus: two large datasets, two different answers
Taiwan's insurance records say yes. A 2017 study in PLoS One followed 185,430 people with CKD and 556,290 people of the same age and sex without it through Taiwan's National Health Insurance Research Database, counting tinnitus only when an otolaryngologist had recorded it at least three times. After adjustment, people with CKD were about three times as likely to be diagnosed with tinnitus: hazard ratio 3.02 (95% CI 2.655–3.456).
The raw figures are much less dramatic. Over follow-up, tinnitus was diagnosed in 0.18% of the kidney disease group and 0.15% of the comparison group, which works out at 97.25 against 72.56 cases per 100,000 person-years, a difference of about a third. The paper does not explain why its adjusted estimate is so much larger than its raw rates, and its authors note that no study has reported how accurately tinnitus is coded in the database.
A 2022 case-control study from the same database looked the other way, at 15,314 people newly diagnosed with CKD by nephrologists and 45,942 matched controls. Tinnitus had been diagnosed beforehand in 3.86% of the kidney disease group and in fewer than 1 in 100 controls, an adjusted odds ratio of 10.97. The authors name the obvious problem themselves: people with tinnitus have more contact with health services, which gives more chances for kidney disease to be found. They judge that bias likely to be limited, since no guideline suggests testing kidney function in people with tinnitus. Their abstract also says the data do not show that tinnitus predicts later kidney disease.
A study using the same database and a similar design found earlier high blood pressure in 35.58% of people with tinnitus and 35.5% of controls: no link (tinnitus and blood pressure).
A US survey says not clearly. NHANES asked everyone, not only people who had seen a doctor, whether ringing or buzzing lasting five minutes or more had bothered them in the past year. Unadjusted, 18.9% of people with CKD said yes against 15.5% without it. Once age alone was taken into account the difference disappeared (odds ratio 1.00, 95% CI 0.83–1.2), and with every adjustment it was 1.19 (95% CI 0.97–1.45), which is not statistically significant.
Some subgroups (women, people aged 45 and over, Black participants, non-smokers, and people with a BMI of 25 or more) did show an association after adjustment. But the study's own tests found the subgroups did not differ significantly from one another, and the authors ask for caution because relatively few participants had tinnitus. The abstract concludes that CKD is associated with both hearing loss and tinnitus; for tinnitus, that rests on the subgroups, not the main analysis.
Why they might disagree. Insurance records count diagnoses, which depend on who sees a doctor and what gets written down. A survey asks everyone the same question, but at 5,131 people it is far smaller. Both are observational, so neither can show that kidney disease causes tinnitus. How to read a tinnitus study covers why designs like these can point in different directions.
Dialysis: where the signal is strongest
In the 2017 Taiwanese data, almost half the kidney disease group, 87,361 people, were on dialysis. Their tinnitus rate was 143.5 per 100,000 person-years, about double the 72.6 in people without kidney disease (adjusted hazard ratio 4.586). The 98,069 people with CKD who were not on dialysis had a raw rate of 66.4, slightly lower than the comparison group, although the adjusted hazard ratio reported for them was 2.461.
A 2024 systematic review of 41 studies of hearing and balance in CKD describes a possible link between time on haemodialysis and tinnitus and vertigo, and concludes that people on haemodialysis face higher risks of hearing loss, tinnitus and balance complaints. A 2020 review cites one study in which time on haemodialysis was the only independent predictor of sensorineural hearing loss.
What a single session does to the ear is less settled. Two small older studies, of 15 and 19 patients, tested hearing before and after a session and found no significant change. A 2026 study of 24 patients found otoacoustic emissions, a sensitive test of cochlear function, weaker three hours after dialysis at every frequency tested. None of the three reported on tinnitus.
Data on how bothersome this tinnitus is are thin. In a Chilean study of 36 adults awaiting a kidney or liver transplant, 38.2% reported tinnitus, and every case scored as slight or mild on the Tinnitus Handicap Inventory.
Why the kidney and the ear might be linked
Researchers point to several routes, none of them shown to cause tinnitus in kidney disease.
- Shared biology. The kidney and the stria vascularis, the tissue that generates the cochlea's internal voltage, both depend on active transport of salts and fluid through the same sodium–potassium pump. A 2020 review lists electrolyte disturbances, raised urea and creatinine, ototoxic drugs, dialysis itself, high blood pressure and diabetes among the suggested causes of hearing loss in CKD.
- Shared causes. Diabetes and high blood pressure are the leading causes of CKD in high- and middle-income countries. Diabetes has a modest link of its own with tinnitus: a meta-analysis of 2,277,719 people put it at an odds ratio of 1.18, covered in diabetes and tinnitus. High blood pressure showed no such link in the Taiwanese study above.
- Genes that affect both organs. Alport syndrome, caused by variants in the COL4A3, COL4A4 or COL4A5 genes, disrupts a collagen found in the basement membranes of both the kidney's filters and the cochlea. It causes progressive kidney disease and sensorineural hearing loss, usually present by late childhood or early adolescence in its more severe forms and later in milder ones. GeneReviews advises a hearing assessment every one to two years from age six or seven, hearing aids as needed, and limiting exposure to loud noise.
- Medicines, covered next.
Medicines: the most concrete connection
Loop diuretics are widely used for fluid overload, heart failure and high blood pressure, and they act on the inner ear by disrupting the stria vascularis. A review in the Journal of Otology describes the hearing loss they cause as usually temporary, and rarely permanent except in severe acute or chronic kidney failure or alongside other ototoxic drugs.
US prescribing information for furosemide injection is more specific. It reports tinnitus and reversible or irreversible hearing loss, usually associated with rapid injection, severe renal impairment, higher than recommended doses, low blood protein, or other ototoxic drugs given at the same time, such as aminoglycoside antibiotics. It also warns that furosemide may increase the ototoxic potential of aminoglycosides, especially when kidney function is impaired.
In the Chilean transplant-candidate study, aspirin use was associated with hearing loss among the kidney patients (P = .003). It is one small study; aspirin and NSAIDs sets out the larger evidence.
None of this is a reason to stop a diuretic on your own. Tell the prescriber about new tinnitus or muffled hearing, and the medication checker can help you prepare the question. Ototoxic medications covers the wider list.
Sudden hearing loss on dialysis needs same-day care
Sudden hearing loss is an emergency for anyone, and the evidence suggests people on dialysis recover less well. In a 2024 Korean study, 47 dialysis patients with sudden hearing loss were matched with 235 patients not on dialysis who were similar in age, starting hearing, other illnesses and treatment. Two months after steroid treatment, 23.4% of the dialysis group had a complete or partial recovery, against 42.1% of the others. In an earlier series of 22 dialysis patients with sudden hearing loss from the same hospital, 68.2% also had tinnitus.
Poorer odds are not no odds: in the dialysis group, 55.3% still showed at least slight improvement by two months.
Pulsatile tinnitus after a fistula or graft
Tinnitus that beats with your pulse has its own causes, covered in pulsatile tinnitus, and one is specific to dialysis. A 2019 case report describes a 51-year-old man who developed a swollen arm and one-sided pulsatile tinnitus two weeks after a graft was created in his upper arm for haemodialysis access. Imaging found a narrowed central vein, with blood flowing backwards up the jugular vein, and tying off the graft ended the tinnitus immediately.
The authors believed it was the first report of its kind, so this is rare. Pulsatile tinnitus after new vascular access, especially with a swollen arm, is still worth reporting to the dialysis team promptly.
Does a kidney transplant fix it?
The evidence is thin and mixed. A Turkish study compared 46 kidney transplant recipients with working transplants, 23 people on haemodialysis and 20 healthy controls, with average ages between 33 and 37. High-frequency hearing thresholds were similar in the transplant and dialysis groups and higher than in the controls. Tinnitus was reported by 41.3% of transplant recipients against 17.4% of the dialysis group.
The authors conclude that hearing loss in kidney disease is likely to be permanent and that transplantation may not improve it, and they raise the possibility that immunosuppressant drugs play a part. But their study compared different people rather than following anyone through a transplant, and they describe two small 1970s studies in which most dialysis patients' hearing returned to normal after transplant, results they treat with caution because dialysis was then less effective and patients took ototoxic drugs. The groups were small and the tinnitus figures come from a questionnaire, so that difference is a question for larger studies, not a finding.
What to do
- Tell your kidney team about new tinnitus or a change in hearing, especially after a change in diuretic dose, an intravenous antibiotic (such as erythromycin), or a new fistula or graft.
- Consider a hearing test. The 2024 systematic review recommends hearing tests for people with CKD whatever the stage of the disease, and a first audiology appointment explains what happens at one.
- If hearing loss is found, it can be treated. Hearing aids have their own evidence for tinnitus when hearing loss is present, and the treatment comparison sets out the rest.
- Treat a sudden drop in hearing as urgent. When to seek care walks through which ear symptoms need same-day attention.