Effect Of Hemodialysis On Visual Acuity And Intraocular Pressure In Patients With End Stage Renal Disease

Abstract

Chronic kidney disease is a worldwide public health problem and is recognized as a common condition with high prevalence rate of about 13-15% with the increase prevalence of diabetes mellitus and hypertension (Levey AS, 2009). The kidney disease outcomes quality initiative of the national kidney foundation (NKF/KDOQI) in 2009 defined chronic kidney disease as either kidney damage or a decreased kidney glomerular filtration rate (GFR) of less than 60 ML/min/1.73 m2 for 3 or more months. Whatever the underlying etiology , the destruction of renal mass with irreversible sclerosis and loss of nephrons lead to a progressive decline in GFR (Johnson D W and Mathew T, 2011). Patients with chronic kidney disease (CKD) are generally treated using a blood- filtration mechanism, such as hemodialysis (HD). During HD, numerous metabolic parameters change, including blood urea, sodium, potassium, and glucose levels, which also induce osmotic changes in blood and extracellular fluids. This includes the aqueous and vitreous humor, changes in which can result in visual acuity, intraocular pressure (IOP) changes (Afshar R, Ghasemi H, 2013). HD patients often complain of both acute and chronic vision changes. Acute changes could be secondary to changes in parameters during HD, but chronic changes most often result from eye disease secondary to the primary cause of renal insufficiency (e.g. diabetes mellitus, hypertension). Best corrected visual acuity was not significantly different before and after a single HD session, but the largest changes were observed in patients with diabetes-related renal failure. Interestingly, diabetic patients tended to show improvements in Best corrected visual acuity with HD, but these changes were not significant. Furthermore, diabetic patients tended to begin dialysis with a lower Best corrected visual acuity than nondiabetic patients. It was demonstrated a positive correlation between Best corrected visual acuity and blood glucose (Ghasemi H, Afshar R, 2012). Visual acuity depends on the health of the cornea, lens, and retina all of which are prone to change during HD and with blood glucose fluctuations (Jung JW, Yoon MH,