Short Term Effect of Hemodialysis on Peripapillary Retinal Nerve Fiber Layer and Macular Thickness

Abstract

Objective: To determine the thicknesses of retinal nerve fiber layer (RNFL) and macula by fourier-domain (FD)optical coherence tomography (OCT) in diabetic patients with end-stage renal failure (ESRF) undergoinghemodialysis.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Pakistan Naval Ship, Shifa Karachi, from Jan 2019 to Jul 2019
 Methodology: Fifty four patients presenting to nephrology department who met the inclusion criteria wereincluded in the study. Macular and retinal nerve fibre layer thicknesses were compared pre and post 30 minutesof hemodialysis and their correlation (r=-0.89) with age, duration of hemodialysis and gender was examined. Pre hemodialysis temporal, inferior, average retinal nerve fibre layer thicknesses were observed thinner than Post hemodialysis.
 Results: Pre-hemodialysis macular thicknesses were thinner than post hemodialysis. Thinning of Macular andRNFL showed a negative relationship with age and duration of hemodialysis (r=-0.89 & -0.76). Temporal, superior quadrants and average retinal nerve fiber layer thickness values were found statistically different in pre and post 30 minutes hemodialysis examination (p-value = 0.002, 0.001 & 0.0021) while, nasal and inferior quadrants were found statistically insignificant. Whereas in macula, temporal and superior quadrants were found statistically significant (p-value=0.005 & 0.002) and nasal, Inferior and average thickness were found statistically insignificant (p-value = 0.0641, 0.0594 & 0.083).
 Conclusion: Macular and retinal nerve fiber layer thicknesses of patients receiving hemodialysis were lessthan the normal population. Age has no effect on these thinning. The duration of hemodialysis effects more than gender. Hemodialysis session causes a consistent.............

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

“…The results of our study regarding the increase in RT as a result of a single HD session are consistent with the results of Wang et al, Atilgan et al, and Jabbar et al [7,15,24]. In this study, we also found a statistically significant increase in total pRNFL thickness, which is in agreement with previous studies by Atilgan et al and Jabbar et al in which a statistically significant increase in pRNFL thickness was found after HD session [7,24].…”

“…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].…”

“…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]. Only two studies assessed the reaction of selected retinal layers to HD sessions [12,13].…”