Study shows significant ocular changes following hemodialysis

A new study from Poland found that one session of hemodialysis caused changes in the anterior and posterior segments of the eye.¹ The investigators, led by Joanna Roskal-Wałek, MD, published their results in the Journal of Clinical Medicine. She is from the Ophthalmology Clinic, Voivodeship Regional Hospital, and the Collegium Medicum, Jan Kochanowski University, both in Kielce, Poland.

The investigators commented, “The growing number of studies are expanding our knowledge of the overall impact of hemodialysis on the visual system, indicating changes in intraocular pressure (IOP), central corneal thickness (CCT), and anterior chamber depth (ACD), along with alterations in the irido-corneal angle, lens thickness, retinal thickness, choroidal thickness, and axial length (AL), as well as vessel density changes. However, these findings present divergent results for almost all the assessed parameters.^2-16 Moreover, the relationships between the ocular changes resulting from one hemodialysis session have yet to be fully assessed.”

Hemodialysis study methodology and results

The investigators conducted a single-center, cross-sectional observational study to determine the effects of a hemodialysis session on the anterior and posterior segments of the eye and the systemic parameters of patients with end-stage renal disease (ESRD) and to examine the correlation of these changes with each other and between changes in systemic stressors related to the hemodialysis session, they explained.

The patients underwent a full ophthalmologic examination that included optical coherence tomography (OCT), OCT angiography, and biometry. Full systemic evaluations also were conducted.

The investigators reported, “Our study generated two major findings. First, a hemodialysis session was associated with significant changes in parameters of both the anterior and posterior segments of the eye. In this study, we found a significant reduction in the ACD and an increase in the lens thickness. A single hemodialysis session was also associated with a significant reduction in the Schirmer test results and a shortening of the tear break-up time (TBUT). In the posterior segment, we observed a significant increase in the AL, central and average macular thickness, and the total vessel density of the total deep capillary plexus (DCP), and a decrease in the central and average choroidal thickness (CT). Second, we demonstrated numerous correlations between these changes, suggesting that they represent a complex response of the eye to the hemodialysis process.”

Specifically, they found that the best-corrected visual acuity improved, and the lens thickness, AL, average macular thickness, central macular thickness, and total vessel density of the DCP increased significantly after one session of hemodialysis. The Schirmer test results, TBUT, ACD, and central and average CT decreased significantly after hemodialysis.

Systemically, the only change they found was weight loss.

Regarding the correlations among the findings, the decreased TBUT was correlated positively with the decreased Schirmer’s test results. The increased CCT was correlated positively with the increased AL. The decreased central and average CT was correlated positively with the decreased IOP. The increased central macular thickness was correlated positively with the increased average macular thickness. The decreased CT was correlated positively with average decreased CT. The changes in the vessel density of the SCP were correlated positively with the changes in the DCP. No correlations were seen between the systemic and ophthalmic parameter changes except for the positive correlation between the systemic blood pressure change and Schirmer’s test result change.

The authors concluded, “Our study showed that hemodialysis affected the parameters of the anterior and posterior segments of the eye. Numerous correlations between these ophthalmologic changes suggest that they are interrelated and represent the complex response of the eye to the hemodialysis process. The significant changes observed in selected ophthalmologic parameters, such as AL and ACD, raise the question of the impact of hemodialysis sessions on IOL power calculation—an issue that should be addressed in future studies. It should also be noted that recurrent changes following hemodynamic sessions (eg, increased retinal thickness and decreased CT) may be responsible for the subsequent decline in CT, retinal thickness, and vessel density values. However, this assumption also requires verification in future studies.”

References

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