Advances in Clinical and Experimental Medicine
2018, vol. 27, nr 1, January, p. 105–110
Publication type: original article
The effect of hemodialysis on intraocular pressure
1 Department of Ophthalmology, Acibadem University School of Medicine, Istanbul, Turkey
2 Internal Medicine Clinic, Memorial Sisli Hospital, Istanbul, Turkey
3 Rentek Dialysis Center, Istanbul, Turkey
Background. The effect of hemodialysis (HD) on intraocular pressure (IOP) has been investigated before, but there is a lack of consensus. Clinicians dealing with renal failure patients are interested in the potential negative effects of HD on IOP and the course of glaucoma.
Objectives. The aim of this study was to investigate the effects of HD on IOP in patients with end-stage renal disease.
Material and Methods. This prospective study included 106 patients who were receiving outpatient hemodialysis. Patient history of systemic and ophthalmologic conditions was recorded. Serum osmolality (mOsm), blood urea nitrogen (BUN), blood glucose (BG), bicarbonate (BC), and hematocrit (Hct) levels at the start of HD (pre-HD), at the end of HD (end-HD), and 30 min after HD (post-HD) were measured. Systolic and diastolic blood pressures (SBP and DBP) and IOP were measured at pre-HD, 1-hour intervals during HD, end-HD, and post-HD.
Results. A significant decrease in mOsm and BUN and a significant increase in BG, BC, and Hct levels were observed at end-HD (p < 0.05). Mean IOP was 16.71 ±2.51 mm Hg at pre-HD, 15.52 ±3.18 mm Hg at endHD, and 15.23 ±2.73 mm Hg at post-HD (p = 0.001; F = 4.439). Post-HD SBP and DBP were significantly lower than at pre-HD (p < 0.001). There was a positive correlation between the change in IOP and the change in mOsm and the change in BUN at end-HD (r = 0.315, p = 0.004; and r = 0.279, p = 0.012, respectively).
Conclusion. IOP decreased significantly during HD in this study. Additional research on the effects of the change in blood parameters and ocular perfusion pressure on IOP and optic nerve perfusion during HD is recommended.
glaucoma, hemodialysis, intraocular pressure
- Lichter PR, Musch DC, Gillespie BW, et al.; CIGTS Study Group. Interim clinical outcomes in Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology. 2001;108:1943–1953.
- Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson, Hussein M; Early Manifest Glaucoma Trial Group. Reduction of intraocular pressure and glaucoma progression: Results from the Early Manifest Glaucoma Trial. Arch Ophthalmol. 2002;120:1268–1279.
- Flammer J, Konieczka K, Bruno RM, Virdis A, Flammer AJ, Taddei S. The eye and the heart. Eur Heart J. 2013;34:1270–1278.
- Mozaffarieh M, Flammer J. New insights in the pathogenesis and treatment of normal tension glaucoma. Curr Opin Pharmacol. 2013;13:43–49.
- He Zeng, Vingrys AJ, Armitage JA, Bui BV. The role of blood pressure in glaucoma. Clin Exp Optom. 2011;94:133–149.
- Sitprija V, Holmes JH, Ellis PP. Changes in intraocular pressure during hemodialysis. Invest Ophthalmol. 1964;3:273–284.
- Leiba H, Oliver M, Shimshoni M, Bar-Khayim Y. Intraocular pressure fluctuations during regular hemodialysis and ultrafiltration. Acta Ophthalmol (Copenh). 1990;68:320–322.
- Tovbin D, Belfair N, Shapira S, et al. High postdialysis urea rebound can predict intradialytic increase in intraocular pressure in dialysis patients with lowered intradialytic hemoconcentration. Nephron. 2002;90:181–187.
- Tokuyama T, Ikeda T, Sato K. Effect of plasma colloid osmotic pressure on intraocular pressure during haemodialysis. Br J Ophthalmol. 1998;82:751–753.
- Hojs R, Pahor D. Intraocular pressure in chronic renal failure patients treated with maintenance hemodialysis. Ophthalmologica. 1997;211:325–326.
- Pelit A, Zumrutdal A, Akova Y. The effect of hemodialysis on visual field test in patients with chronic renal failure. Curr Eye Res. 2003;26:303–306.
- Nongpiur ME, Wong TY, Sabanayagam C, Lim SC, Tai ES, Aung T. Chronic kidney disease and intraocular pressure: The Singapore Malay Eye Study. Ophthalmology. 2010;117:477–483.
- Gafter U, Pinkas M, Hirsch J, Levi J, Savir H. Intraocular pressure in uremic patients on chronic hemodialysis. Nephron. 1985;40:74–75.
- Masuda H, Shibuya Y, Ohira A. Markedly increased unilateral intraocular pressure during hemodialysis in a patient with ipsilateral exfoliative glaucoma. Am J Ophthalmol. 2000;129:534–536.
- Klein BE, Klein R, Knudtson MD. Intraocular pressure and systemic blood pressure: Longitudinal perspective: The Beaver Dam Eye Study. Br J Ophthalmol. 2005;89:284–287.
- Samsudin A, Mimiwati Z, Soong T, Fauzi MS, Zabri K. Effect of haemodialysis on intraocular pressure. Eye (Lond). 2010;24:70–73.
- Fauchald P. Transcapillary colloid osmotic gradient and body ﬂuid volumes in renal failure. Kidney Int. 1986;29:895–900.
- Palmer BF, Henrich WL. Recent advances in the prevention and management of intradialytic hypotension. J Am Soc Nephrol. 2008;19:8–11.
- Memarzadeh F, Ying-Lai M, Chung J, Azen SP, Varma R; Los Angeles Latino Eye Study Group. Blood pressure, perfusion pressure, and open-angle glaucoma: The Los Angeles Latino Eye Study. Invest Ophthalmol Vis Sci. 2010;51:2872–2877.
- Keller KE, Acott TS. The juxtacanalicular region of ocular trabecular meshwork: A tissue with a unique extracellular matrix and specialized function. J Ocul Biol. 2013;1:3.
- Khawaja AP, Chan MP, Broadway DC, et al. Systemic medication and intraocular pressure in a British population: The EPIC-Norfolk Eye Study. Ophthalmology. 2014;121:1501–1507.
- Whitacre MM, Stein R. Sources of error with use of Goldmann-type tonometers. Surv Ophthalmol. 1993;38:1–30.
- Whitacre MM, Stein RA, Hassanein K. The effect of corneal thickness on applanation tonometry. Am J Ophthalmol. 1993;115:592–596.