Hemodialysis May Increase Intraocular Pressure

November 28, 2013

By Rob Goodier

NEW YORK (Reuters Health) Nov 28 - Hemodialysis appears to raise the intraocular pressure to levels that could exacerbate or increase the risk of developing glaucoma, researchers have found.

In a study of 49 patients, intraocular pressure increased by an average of 3.1 mm Hg during hemodialysis and surpassed thresholds for higher risk for open-angle glaucoma, they report in JAMA Ophthalmology, online November 14.

"We recommend in standard practice to have an increased awareness of the potential association of hemodialysis and glaucoma, and measures to maintain blood pressure and lower the intraocular pressure during hemodialysis sessions can be considered in certain patients," lead author Dr. Jennifer Hu of the University of Illinois at Chicago told Reuters Health.

In the study, Dr. Hu and her colleagues measured intraocular and blood pressure before, during and after the hemodialysis session.

The intraocular pressure rose significantly in both eyes during dialysis. For example, in the left eye it increased from 17.7 mm Hg 15 minutes before dialysis to 19.2 mm Hg two hours after starting the procedure to 20.8 mm Hg 15 minutes after its completion (p<0.001).

Meanwhile, arterial pressure dropped by 5.8 mm Hg and ocular perfusion pressure decreased by an average of 8.7 to 8.9 mm Hg. And all three ocular perfusion pressure measures -- systolic, diastolic and mean -- showed significant decreases during the session.

The pressure changes surpassed the thresholds for higher open-angle glaucoma risk established in the Barbados Eye Studies, the researchers note. Using the thresholds for ocular perfusion pressure as a measure, 53% of the right eyes and 46% of the left eyes had a systolic ocular perfusion pressure of 101 mm Hg or less, which is tied to a 2.6-fold increase in risk for open-angle glaucoma.

Likewise, 71% of the right eyes and 73% of the left eyes had a diastolic ocular perfusion pressure of 55 mm Hg or less, associated with a 3.2-fold higher risk.

And 63% of the right eyes and 65% of the left eyes had a mean ocular perfusion pressure of 42 mm Hg or less (3.1 times greater glaucoma risk).

"Ophthalmologists and nephrologists should collaborate to ensure sufficient blood pressure and ocular perfusion pressure during hemodialysis in high-risk patients, such as those with advanced glaucoma," the researchers write.

SOURCE: http://bit.ly/1aCBvid

JAMA Ophthalmol 2013.

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