Risk of Nonarteritic Anterior Ischemic Optic Neuropathy Following End-Stage Renal Disease

Abstract

To investigate the risk of nonarteritic anterior ischemic optic neuropathy (NAION) following end-stage renal disease (ESRD).A retrospective, nationwide, matched cohort study.ESRD patients identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 585.The study cohort included 93,804 ESRD patients registered with the Taiwan National Health Insurance Research Database between January 2000 and December 2009. An age- and sex-matched control group comprised 93,804 patients (case:control = 1:1) selected from the Taiwan Longitudinal Health Insurance Database 2000. Information for each patient was collected from the index date until December 2011. The incidence and risk of NAION were compared between the ESRD and control groups. The adjusted hazard ratio (HR) for NAION after adjustment for potential confounders was obtained by a Cox proportional hazard regression analysis. A Kaplan–Meier analysis was used to calculate the cumulative incidence rate of NAION.The incidence of NAION following ESRD.In total, 133 ESRD patients (0.14%) and 51 controls (0.05%) had NAION (P < 0.001) during the follow-up period, leading to a significantly elevated risk of NAION in the ESRD patients compared with the controls (incidence rate ratio = 3.14, 95% confidence interval [CI] = 2.11–4.67). After adjustment for potential confounders including diabetes mellitus, hypertension, hypotension, hyperlipidemia, and 2-way interaction terms between any 2 factors, ESRD patients were 3.12 times more likely to develop NAION than non-ESRD patients in the full cohort (adjusted HR = 3.12, 95% CI = 2.10–4.64). Additionally, patients with hypertension and hyperlipidemia showed higher incidence rates of NAION in the ESRD group compared with the controls: 2.31 (95% CI = 1.40–3.82) for hypertension and 2.72 (95% CI = 1.14–6.50) for hyperlipidemia.ESRD increased the risk of NAION, which is an interdisciplinary emergency. Close collaboration between nephrologists and ophthalmologists is important in NAION management following ESRD to prevent fellow eye involvement.

Anterior Ischemic Optic Neuropathy in a Child Receiving Chronic Hemodialysis

“…AION results from poor perfusion of the optic nerve and is a rare but serious condition that can occur in patients on chronic dialysis [2]. e optic nerve is supplied by the posterior ciliary arteries which arise from the ophthalmic artery [3].…”

“…On the other hand, children do not have risk factors associated with aging, and infarction of the optic nerve is more commonly related to systemic hypotension [3]. Risk factors in children include young age at dialysis onset, chronic hypotension (often with previous hypertension), history of bilateral nephrectomy, autosomal recessive polycystic disease, and anemia [1,2,5].…”

“…Anterior ischemic optic neuropathy (AION) is characterized by hypoperfusion of the posterior ciliary arteries resulting in optic nerve infarction [1]. AION has been reported as a complication of hypotension secondary to chronic dialysis in adult patients, but it is much less common in children [2]. To our knowledge, only 22 cases of pediatric AION have been reported and all of them were receiving peritoneal dialysis [1,[3][4][5].…”

Ocular Manifestations in Diabetes-Related Chronic Renal Failure Patients in a Tertiary Care Centre

“…Close collaboration between nephrologists and ophthalmologists is important in NAION management following ESRD to prevent fellow eye involvement. 13 The early treatment diabetic retinopathy study has classified DR into nonproliferative, proliferative retinopathy and diabetic maculopathy. This classification aims to predict degree of visual loss and timing for intervention to reduce progression and preserve vision.…”

Repeated intravitreal injections of antivascular endothelial growth factor in patients with neovascular age-related macular degeneration may increase the risk of ischemic optic neuropathy

“…Of these, nonarteritic anterior ION (NAION) is the most common type. The risk factors for NAION include a crowded optic disk, diabetes, hypertension, hyperlipidemia, and ischemic heart disease [13][14][15][16][17]. Diminished ocular blood perfusion due to elevated intraocular pressure (IOP) or glaucoma can also lead to the occurrence of ION [18][19][20][21][22][23].…”