COMMENTARY

Intraocular Pressure and Hemodialysis

Shuchi B. Patel, MD

Disclosures

March 17, 2014

Effect of Hemodialysis on Intraocular Pressure and Ocular Perfusion Pressure

Hu J, Bui KM, Patel KH, et al
JAMA Ophthalmol. 2013;131:1525-1531

Study Summary

It is well established that elevated intraocular pressure (IOP) is a risk factor for glaucoma development and progression. Many factors can increase IOP. Systemic variables that may affect IOP are changes in blood volume, plasma osmolarity, and colloidal osmotic pressure. Hemodialysis affects all of these parameters, and given the significant number of patients on dialysis, this could be an important factor in IOP control.

Therefore, a cross-sectional observational study was conducted in patients undergoing hemodialysis at an ambulatory care clinic at the University of Illinois at Chicago. Forty-nine patients (97 eyes) undergoing hemodialysis were enrolled. Nine patients had previous diagnoses of open-angle glaucoma or suspected glaucoma. Patients with corneal abnormalities, history of corneal surgery, allergy to topical anesthetic agents, or a current eye infection were excluded.

Measurements were made at 3 time points, using a pneumatonometer with the patient in a seated position: approximately 15 minutes before starting hemodialysis (T1), approximately 2 hours after starting hemodialysis (T2), and approximately 15 minutes after ending hemodialysis (T3). Blood pressures were also measured at these times, and mean arterial pressure and ocular perfusion pressure (OPP) were calculated.

The results showed that from T1 to T3, IOP significantly increased by 3.1 mm Hg (both eyes, P < .001), mean arterial pressure was significantly lower by 5.8 mm Hg (P = .05), and all OPP measures significantly declined from baseline (P ≤ .02 for all). There was also a significant increase in colloid osmotic pressure of 2.8 mm Hg (P = .004) across the hemodialysis sessions. However, there were no significant correlations between changes in IOP or OPP and systemic hemodialysis factors (changes in plasma osmolarity, rate of change in plasma osmolarity, change in colloid osmotic pressure, dialysis rate, volume of ultrafiltrated fluid, and change in body weight).

From these results, Hu and colleagues concluded that a significant increase in IOP and reduction in OPP occur during hemodialysis, bringing both to levels that increase the risk for glaucoma development and progression.

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