Effect of haemodialysis on retinal circulation in patients with end stage renal disease

Abstract

Aims: To investigate the effect of haemodialysis on retinal circulation in patients with end stage renal disease (ESRD). Method: Seventeen consecutive patients with ESRD were recruited into the study. The authors simultaneously measured changes in vessel diameter and blood velocity and calculated the retinal blood flow (RBF) in the retinal veins in patients with ESRD before and after haemodialysis using a laser Doppler velocimetry system. In addition, the relations between the changes in systemic and retinal circulatory parameters were examined.Results: There was a group averaged increase in vessel diameter (p = 0.003) after haemodialysis. However, the blood velocity and RBF values obtained after haemodialysis were not significantly different from those before haemodialysis (p = 0.66 and p = 0.63, respectively). The changes in vessel diameter were negatively (r = 20.549, p = 0.02) correlated with the change in MABP, but the changes in blood velocity and RBF were positively correlated with the change in MABP (r = 0.683, p,0.002 and r = 0.589, p,0.01, respectively). The change in RBF was also inversely correlated with the increase in haematocrit (r = 20.693, p,0.002) and the amount of fluid removed (r = 20.597, p,0.01). Conclusion:The results indicate that haemodialysis and the associated changes in systemic circulatory parameters may affect the retinal circulation in patients with ESRD.

Evaluation of choroidal and retinal thickness measurements in adult hemodialysis patients using spectral-domain optical coherence tomography

“…The main mechanism driving diminished retinal blood flow during hemodialysis is hypothesized to be related to the amount of fluid removed during hemodialysis. Retinal blood flow and the amount of fluid removed by hemodialysis were found to be negatively correlated (6) . Because the aim of hemodialysis is to correct the abnormal distribution of bodily fluids, ocular hemodynamics are expected to be affected by this rearrangement.…”

Microvascular Dilatation after Haemodialysis Is Determined by the Volume of Fluid Removed and Fall in Mean Arterial Pressure

“…Retinal venular dilatation has been described previously after dialysis using colour Doppler ultrasonography and laser Doppler velocimetry [16,17], but our study measured vessel calibre directly, and assessed the determinants of the vasodilation. Microvascular grading is convenient because it does not require the use of special equipment but only access to a vascular calibre grading centre.…”

“…Both arterioles and venules are narrowed in renal failure, and the more severe the renal failure, the smaller the vessel diameter [28]. However, microvascular calibre is also dynamic, and may be affected by fluid status and vasoactive stimuli [16,17], but not, in population-based surveys, by commonly-used medications [29]. …”

“…Dialysis is sometimes associated with hypotension, headache, nausea, muscle cramps and cardiac ischemia, and while the mechanisms are incompletely understood, changes in the microvascular blood flow have been demonstrated [16,17]. …”

“…Retinal changes in microvascular disease include focal and generalised arteriolar narrowing, arteriovenous nicking, haemorrhage and exudates [10,11,12]. Specialised methods use quantitative computer-based techniques to measure retinal vessel calibre directly from digital images [13,14,15], or indirectly, from blood flow using Doppler ultrasonography [16,17]. Changes in vessel branching patterns or ‘fractals’ that reflect ischemia can also be assessed from digitised retinal images [18,19].…”