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

Abstract

PURPOSE: The purpose was to study the effect of hemodialysis (HD) on macular thickness in patients with diabetic retinopathy (DR) and end-stage renal disease. MATERIALS AND METHODS: In this prospective observational study, patients undergoing HD for diabetic nephropathy were recruited. None of the patients received treatment for DR per se during the study duration. Patients underwent ocular examination and optical coherence tomography before HD and were followed up on day 3 and day 30. At each visit, central subfield macular thickness (CSMT) and total macular volume (TMV) were measured and compared with baseline values using analysis of variance and post hoc test (Wilcoxon's matched-pairs signed-rank test). RESULTS: Thirty-one eyes of 19 patients were recruited in the study. The mean CSMT decreased from baseline value of 278.93 ± 45.01 μ to 239.81 ± 40.54 μ at the end of 30 days (P < 0.005). The mean TMV decreased from baseline value of 8.14 ± 0.68 mm3 to 7.80 ± 0.63 mm3 on day 30 (P < 0.005). CONCLUSION: There was a statistically significant reduction in CSMT and TMV after HD at 30 days as compared to baseline values. HD alone results in reduction of macular thickness over short term.

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

“…However, a significant number of studies indicate no effect of an HD session on RT or even a decrease in RT after HD [6,12,13,[16][17][18][19][20][21][22][23]25,26]. The differences may be due to small groups of subjects, methodological differences between studies, differences in the OCT types used, and differences in the groups of subjects themselves, including age, gender, axial length, refraction, or ethnic origin, all of which influence the retinal, GCL and pRNFL thickness [6,7,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]30]. The aetiology of CKD in the studied patients subjected to HD may be of particular importance with respect to differences in the obtained results.…”

“…The impact of DM and the associated microangiopathy may affect not only the baseline RT but also its response to HD. The available literature includes studies assessing RT in the NDM group only [7,15,18,25], mixed groups of DM and NDM patients [6,[12][13][14]16,17,19,[21][22][23]26] or DM patients who were also assessed with respect to the degree of DR or the presence of macular oedema [20,24,31].…”

“…It is worth noting that repeated changes in parameters related to retinal and pRNFL thickness caused by HD may have a long-term effect [7,20]. In the study by Atilgan et al, the RNFL and macular thickness before and after HD in NDM patients were assessed on the first day, after one month and then after six months.…”

“…As indicated above, the currently available study results are very diverse, and the reasons for the reduction, lack of reaction or increase in RT and pRNFL thickness following HD observed in previous studies are not clear [6,7,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]36]. There is no doubt that further research is needed, including the use of OCT-A, which will allow us to address changes in microcirculation and their potential impact on RT.…”

“…The way that the retina reacts to a single HD session is not obvious, and the studies give contradictory results, from RT decrease through no changes to RT thickness increase [6,7,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The changes regarding pRNFL also differ in respective studies [7,13,19,24].…”