Prevalence of Intraocular Pressure Changes In Regular Hemodialysis Patients

Abstract

End-stage kidney disease (ESKD) is highly prevalent globally. It has become a major public health problem and is associated with considerable co-morbidity and mortality. Despite the widespread use of peritoneal dialysis and renal transplantation, hemodialysis (HD) remains the main renal replacement therapy in most countries worldwide. In Egypt, End-stage renal disease (ESRD) is one of the main health problems. Currently, hemodialysis represents the main mode for treatment of chronic kidney disease stage 5 (CKD5), previously called ESRD or chronic renal failure. The aim of our study is to determine the prevalence of high intraocular pressure in hemodialysis patients. Our current study was conducted among sixty patients in regular hemodialysis (120 eyes); all patients were under maintenance conventional intermittent hemodialysis for at least six months in Eldemerdash hospital in the period from May to December 2015. In all patients we recorded full history and clinical examination stressing on etiology of renal disease and full ocular examination (intra ocular pressure measurement, anterior segment, posterior segment, refraction and best corrected visual acuity) for at least six months. Our study population including sixty patients with the ages ranged from 18 to 60 years (mean, 44 ± 11.1 years) were evaluated. Among these patients, 29 (48.3%) were males and 31 (51.7%) were females, the mean BMI (28.3 ± 5.4kg/m2), among the patients, 35 (58.3%) were hypertensive, 25 (41.7%) were none hypertensive, 32 (53.3%) of patients HCV Ab positive and 28(51.7) HCV negative. Results of our study demonstrated that there were many causes for ESRD in the study population, where HTN 23.4 %, unknown etiology 23.3%, chronic glomerulonephritis 16.7%, analgesic nephropathy 15%, ADPKD 6.7%, chronic pyelonephritis 8.4%, reflux nephropathy 3.3% and obstructive uropathy 3.3%. Diabetes mellitus was excluded from our study as there is association between diabetes and primary open-angle glaucoma. In our study we found that most of the patients receive three HD sessions /week each session lasting four hours, this was with KDOQI guidelines recommendations for HD adequacy. In our study, we found that 83.3% of patients were using AVF, 10 % were using AVG while 6.7 % were using venous catheter. In our study we found that the prevalence of high intraocular pressure (IOP) among studied population was 31 patients (51.66%) and normal (IOP) 29 patients (48.33), prevalence of high intraocular pressure of right eye (22 eyes) (36.7%) and prevalence of high intraocular pressure of left eye (28 eyes) (46.7%) above the mean intraocular pressure of normal population. Twelve patients out of 60 (20%) of these group were unilateral and 19 out of 60 (31.7) were bilateral of high intraocular pressure. So increased intraocular pressure during dialysis bringing them to level that increased the risk of glaucoma development and progression. In our study the mean intra ocular pressure of right eye (mean 15.7± 2.6) and the mean intra ocular pressure of left eye (mean 16.5± 2.8). In our study there was statically significant correlation between intradialytic weight gain and intra ocular pressure in end stage renal disease patients as with more intradialytic weight gain the more increased with intraocular pressure.