The impact of hemodialysis on retinal and choroidal thickness in patients with chronic renal failure

The effects of hemodialysis on the eye

The purpose of this study was to examine the effects of hemodialysis on the eye and its long-term consequences. Hemodialysis is a process that purifies the blood and maintains the balance of water, solutes, acid-base, and electrolytes. The eye, being primarily composed of fluid, has been speculated to be affected by this technique. To analyze these effects, a literature review was conducted, focusing on the anatomical structures, functions, and changes in the eye following hemodialysis. The search for relevant articles was carried out on PubMed, including studies published in English between 2000 and 2023. The results of the review showed that certain observations such as visual acuity, refraction, intraocular pressure, biometric parameters, and retinal nerve fiber layer did not show significant timing-related impacts, or there were conflicting findings. However, a connection was established between hemodialysis sessions and visual fields, parameters of visual-evoked potential, intraocular pressure in glaucoma, tear break-up time, Schirmer's test values, choroidal thickness, flow velocities of vessels, and ocular perfusion pressure values. In conclusion, it was determined that hemodialysis sessions can cause fluctuations that may complicate the assessment of eye health. To obtain a more accurate baseline evaluation, it is recommended to schedule ophthalmological examinations, a few hours after the hemodialysis session. Additionally, it is important to provide appropriate management for dry eyes and ocular hypertension, particularly during hemodialysis sessions. Coordination of these examinations with the timing of renal replacement therapy is advised to ensure optimal patient care.

Advanced hemodialysis systems: Assessing inflammatory biomarkers, renal analytics, and metabolic stability in elderly patients with chronic kidney disease

BackgroundChronic kidney disease (CKD) in the elderly necessitates innovative therapeutic technologies to address systemic complications. Advanced hemodialysis systems, integrating real-time biochemical monitoring and optimized filtration, offer potential enhancements in clinical outcomes, yet their impact on inflammatory pathways and metabolic equilibrium remains underexplored.ObjectiveThis study evaluated the efficacy of a next-generation hemodialysis system in modulating inflammatory biomarkers, renal function parameters, and calcium-phosphorus homeostasis among elderly CKD patients.MethodsEighty-four elderly CKD patients were randomized into a control group (standard therapy) and an intervention group (standard therapy + advanced hemodialysis). The intervention utilized a fully automated dialysis machine with bicarbonate dialysate, precision-calibrated blood flow (180-200 mL/min), and real-time metabolic tracking. Serum levels of TNF-α, IL-6, IL-1, hs-CRP, BUN, Scr, β2-MG, calcium, phosphorus, and Ca × P were analyzed pre- and post-intervention using ELISA and biochemical assays.ResultsThe intervention group demonstrated a higher total efficacy rate (85.71% vs. 64.29%, P < 0.05). Post-treatment, significant reductions in inflammatory markers (TNF-α: 1.35 ± 0.24 vs. 4.06 ± 0.42 ng/mL; IL-6: 13.05 ± 1.52 vs. 17.62 ± 2.24 ng/L), renal toxins (BUN: 7.82 ± 1.75 vs. 10.12 ± 2.02 mmol/L; Scr: 401.32 ± 15.76 vs. 489.95 ± 16.14 μmol/L), and phosphorus (1.62 ± 0.34 vs. 2.16 ± 0.46 mmol/L) were observed (P < 0.05). Calcium levels improved (3.19 ± 0.56 vs. 2.26 ± 0.53 mmol/L), alongside stabilized Ca × P products (52.92 ± 5.05 vs. 60.34 ± 7.06 mg2/dL).ConclusionAdvanced hemodialysis systems significantly enhance therapeutic outcomes in elderly CKD patients by attenuating inflammation, restoring renal function, and optimizing calcium-phosphorus metabolism. These findings underscore the clinical value of integrating technology-driven dialysis protocols for precision care.

The effect of long-term hemodialysis on diabetic retinopathy observed by swept-source optical coherence tomography angiography

BACKGROUND

Diabetes can cause chronic microvascular complications such as diabetic retinopathy (DR) and diabetic nephropathy (DN). DR and DN can lead to or exacerbate diabetic macular edema (DME). Hemodialysis (HD) is the main treatment method for patients with end-stage kidney disease (ESKD) secondary to DN.

PURPOSE

The aim of this prospective cohort study was to determine the immediate effect of single HD session on retinal and choroidal thickness in DR patients with ESKD and the features of DR and the prevalence of DME in these patients who have received long-term HD.

METHODS

Eighty-five eyes of 44 DR patients with ESKD who underwent long-term HD were examined by swept-source optical coherence tomography angiography (SS-OCTA). Based on OCTA images, the characteristics of DR and the prevalence of DME in these patients were analyzed. Changes in central retinal thickness (CRT), central retinal volume (CRV), subfoveal choroidal thickness (SFCT) and subfoveal choroidal volume (SFCV) within 30 min before and after single HD session were compared. CRT, CRV, SFCT and SFCV were compared before single HD session and before the next single HD session.

RESULTS

There was no significant difference in the average CRT (251.69 ± 39.21 μm vs. 251.46 ± 39.38 μm, P = 0.286) or CRV (0.15 ± 0.62 μm vs. 0.15 ± 0.63 μm, P = 0.324) between before and after single HD session. After single HD session, SFCT (243.11 ± 77.15 μm vs. 219.20 ± 72.84 μm, P < 0.001) and SFCV (0.15 ± 0.10 μm vs. 0.13 ± 0.90 μm, P < 0.001) significantly decreased. There was no statistically significant difference in CRT (251.69 ± 39.21 μm vs. 251.11 ± 38.47 μm, P = 0.206), CRV (0.15 ± 0.62 μm vs. 0.15 ± 0.61 μm, P = 0.154), SFCT (243.11 ± 77.15 μm vs. 245.41 ± 76.23 μm, P = 0.108), or SFCV (0.15 ± 0.10 μm vs. 0.16 ± 0.10 μm, P = 0.174) before HD and before the next single HD session. On en face OCTA images, eighty-five eyes (100%) had retinal nonperfusion areas, foveal avascular zone (FAZ) enlargement, and abnormal retinal microvasculature. Based on cross-sectional OCTA images, retinal neovascularization (RNV) was confirmed in 42 eyes (49.41%), and intraretinal microvascular abnormalities (IRMAs) were detected in 85 eyes (100%). Seventeen eyes (20%) still had DME, all of which were cystoid macular edema (CME). Among eyes with DME, the epiretinal membrane (ERM) was present in 7 eyes (8.24%).

CONCLUSIONS

For DR patients with ESKD who have undergone long-term HD, the choroidal thickness still changes significantly before and after single HD session, which may be related to short-term effects such as reduced blood volume and plasma osmotic pressure caused by single HD session. Although macular features seem to have stabilized in DR patients undergoing long-term dialysis, the DR of patients with ESKD should still be given attention.

The Haemodialysis Session Effect on the Choroidal Thickness and Retinal and Choroidal Microcirculation-A Literature Review

Haemodialysis (HD) is currently the most commonly used method of renal replacement therapy. The process of dialysis involves numerous changes that affect many systems, including the eye. The changes occurring in the course of HD may affect the ocular parameters, such as intraocular pressure, central corneal thickness, retinal thickness, retinal nerve fibre layer thickness, and choroidal thickness (CT). The choroid, being one of the most vascularized tissues, is characterized by the highest ratio of blood flow to tissue volume in the entire body, may be particularly susceptible to changes occurring during HD, and at the same time reflect the microcirculatory status and its response to HD. Patients with end-stage renal disease subjected to dialysis are highly susceptible to systemic microvascular dysfunction. Moreover, it is considered that the process of HD itself contributes to vascular dysfunction. Nowadays, thanks to the development of imaging techniques, the widely available optical coherence tomography (OCT) tests allow for the assessment of CT, while OCT-angiography allows for a quick, non-invasive, and repeatable assessment of the condition of retinal and choroidal microcirculation, which significantly expands our knowledge regarding the reaction of ocular microcirculation due to HD. The assessment of both retinal and choroidal circulation is even more attractive because retinal circulation is autoregulated, while choroidal circulation is mainly controlled by extrinsic autonomic innervation. Thus, assessment of the choroidal response to an HD session may provide the possibility to indirectly evaluate the functions of the autonomic system in patients subjected to HD. At a time when the importance of microcirculation in systemic and renal diseases is becoming increasingly evident, the assessment of ocular microcirculation appears to be a potential biomarker for assessing the condition of systemic microcirculation. In this work, we present a review of the literature on the effect of the HD session on CT and the retinal and choroidal microcirculation.

Optical coherence tomography findings in three patients with Werner syndrome

Background

Werner syndrome is a rare, autosomal recessive disorder characterised by premature aging. It is a typical hereditary progeroid syndrome that can be difficult to diagnose owing to its rarity and the similarity of some of its symptoms, such as juvenile cataracts, to other common ophthalmologic conditions. Early onset of bilateral cataracts is currently used as the ophthalmological feature for Werner syndrome; however, ophthalmologists often find performing a detailed examination of the medical history and genetic testing for Werner syndrome at the time of an ophthalmologic consultation challenging. If a unique ocular finding was observed on ocular examinations in cases of juvenile bilateral cataracts, we could consider Werner syndrome as a differential diagnosis. 

Case presentation

We documented the cases of three patients with Werner syndrome in whom thinning of the retina in the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) were observed using optical coherence tomography (OCT). Visual field tests revealed the loss of visual field mainly owing to glaucoma.

The thinnig of the choroidal thickness (CT) in three patients was also observed using enhanced depth imaging (EDI)-OCT.

Conclusions

Three patients have thinning of the RNFL, GCC, and choroidal thickness and the loss of visual field. These findings suggest the need for including Werner syndrome in the differential diagnosis when patients presenting with juvenile cataracts of unknown cause also show abnormal retinal and choroidal thinning in the OCT images.

Clinical Characteristics and Mathematical Analysis of Curative Effect of Hemodialysis in Curing Poisoning Caused by Snakebite

In order to explore the clinical characteristics of hemodialysis in curing poisoning from snakebites, a two-classification model of nuclear logistic neural network based on restricted Boltzmann machine is proposed. The model combines kernel logistic regression with artificial neural networks, enabling the model to both learn autonomously and handle linearly inseparable problems. The network first performs feature learning through unsupervised training of restricted Boltzmann machines and obtains the initial values of the parameters to be identified, which reduces the influence of the randomness of the initial parameters. The variable universe learning rate with scaling factor is used to learn the parameters to be identified, and the model convergence speed is improved by dynamic adjustment of the learning rate. Experimental results show the following: Compared with before treatment, patient's activated partial thromboplastin time (APTT) after treatment and the prothrombin time (PT) level decrease, fibrinogen (FIB) levels are elevated, aspartate transferase (AST) and creatine kinase isoenzyme (CK-MB) level decreased, and the differences were statistically significant (p < 0.05). It is proved that continuous hemodiafiltration combined with plasma exchange treatment can effectively improve the blood coagulation index and myocardial index of severe snakebite poisoning patients.