A study of effect of hemodialysis on macular thickness in patients with end-stage renal disease

The Impact of a Single Haemodialysis Session on the Retinal Thickness and Optic Nerve Morphology

BACKGROUND

The aim of the study was to assess the influence of a single haemodialysis (HD) session on the retinal and optic nerve morphology in end-stage kidney disease (ESKD) patients.

METHODS

It is a prospective study including only the right eye of 35 chronic kidney disease (CKD) patients subjected to HD. Each patient underwent a full eye examination 30 min before HD (8 a.m.) and 15 min after HD. Optical coherence tomography (OCT) was used to assess the peripapillary retinal nerve fibre layer (pRNFL) thickness, macular nerve fibre layer (mRNFL) thickness, ganglion cell layer with inner plexiform layer thickness (GCL+), GCL++ (mRNFL and GCL+) thickness, total retinal thickness (RT) and total macular volume (TMV). The correlation was tested between such systemic parameters changes as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), body weight, plasma osmolarity and ocular perfusion pressure (OPP) and ultrafiltration volume with total RT and pRNFL thickness changes during HD.

RESULTS

In the results of a single HD session, we could observe a statistically significant increase in the total RT thickness (pre-HD 270.4 ± 19.94 μm, post-HD 272.14 ± 20.11 μm; p = 0.0014), TMV (pre-HD 7.48 ± 0.53 mm3, post-HD 7.52 ± 0.55 mm3; p = 0.0006), total pRNFL thickness (pre-HD 97.46 ± 15.71 μm, post-HD 100.23 ± 14.7 μm; p = 0.0039), total GCL+ thickness (pre-HD 70.11 ± 9.24 μm, post-HD 70.6 ± 9.7 μm; p = 0.0044), and GCL++ thickness (pre-HD 97.46 ± 12.56 μm, post-HD 97.9 ± 12.94 μm; p = 0.0081). We observed a significant correlation between the change in total RT and DBP change, as well as between body weight change and the change in total pRNFL thickness. There was also a correlation between total pRNFL thickness change and the presence of diabetes mellitus.

CONCLUSION

Even a single HD session affects the retinal and pRNFL thickness, which should be taken into account when interpreting the OCT results in patients subjected to HD. The impact of changes after a single HD session on selected parameters requires further assessment in subsequent studies, including long-term observation.

The effect of hemodialysis on macular thickness

Introduction/Objective. During hemodialysis (HD) treatment great fluctuations were recorded in the systemic hemodynamic parameters and in the volume and composition of ocular fluid. There are only a few studies that analyzed the effect of HD on retinal and macular thickness with conflicting results. Objective of this study was to determine macular thickness, marked as central foveal thickness, average macular thickness and macular volume, shortly before and after HD. Methods. Prospective study of 30 chronic renal failure (CRF) patients on HD treatment. Thorough ophthalmologic examinations were performed including evaluation of best corrected visual acuity, intraocular pressure and slit-lamp examination of all eye segments. Macular thickness was determined by optical coherence tomography shortly before and after HD. The next parameters were evaluated: central foveal thickness, average macular thickness and macular volume. The correlation between systemic parameters and macular thickness changes during HD was tested. Results. There were significant changes in body weight and blood pressure pre- and post-HD. Results showed macular thickness (central foveal thickness, average macular thickness and macular volume) decreased, but the change was not significant. There was no significant correlation between systemic hemodynamic parameters and macular thickness changes. Conclusion. Results of this study showed there was no statistically significant changes in macular thickness CRF patient undergoing HD. Further research on a larger group of patients and a longer follow-up time are required to confirm these findings.