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Original Investigation | Clinical Sciences

Effect of Hemodialysis on Intraocular Pressure and Ocular Perfusion Pressure

Jennifer Hu, MD1; Kelly M. Bui, MD1; Kevin H. Patel, MD1; Hajwa Kim, MA, MS2; Jose A. L. Arruda, MD3; Jacob T. Wilensky, MD1; Thasarat S. Vajaranant, MD1
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago
2Center for Clinical and Translational Science, University of Illinois at Chicago
3Department of Medicine, University of Illinois at Chicago
JAMA Ophthalmol. 2013;131(12):1525-1531. doi:10.1001/jamaophthalmol.2013.5599.
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Importance  Elevated intraocular pressure (IOP) and decreased ocular perfusion pressure (OPP) are risk factors for glaucoma development and progression. Unrecognized significant IOP elevation or OPP reduction during hemodialysis (HD) could lead to glaucomatous optic nerve damage and subsequent visual loss.

Objective  To evaluate changes in IOP and OPP during HD.

Design, Setting, and Participants  A cross-sectional observational study was conducted in patients undergoing HD at an ambulatory care clinic at the University of Illinois at Chicago.

Exposures  Forty-nine patients (97 eyes) undergoing HD were enrolled. Exclusion criteria included preexisting corneal abnormalities, history of corneal surgery, allergy to topical anesthetic agents, and current eye infection. Nine patients had previous diagnoses of open-angle glaucoma (OAG) or suspected glaucoma. At 3 time points, IOP was measured using a pneumatonometer and blood pressure was recorded. Measurements were made with the patient in a seated position approximately 15 minutes before starting HD (T1), approximately 2 hours after starting HD (T2), and approximately 15 minutes after ending HD (T3). Mean arterial pressure (MAP) and OPP (systolic, diastolic, and mean OPP) were calculated.

Main Outcomes and Measures  Intraocular pressure and OPP.

Results  From T1 to T3, IOP significantly increased by 3.1 mm Hg (both eyes, P < .001), MAP significantly decreased by 5.8 mm Hg (P = .05), and all OPP measures significantly decreased from baseline (all P ≤ .02). Using previously reported thresholds of increased glaucoma development and progression risk, 53% of the right eyes (26 of 49) and 46% of the left eyes (22 of 48) had a systolic OPP of 101 mm Hg or less, 71% of the right eyes (35 of 49) and 73% of the left eyes (35 of 48) had a diastolic OPP of 55 mm Hg or less, and 63% of the right eyes (31 of 49) and 65% of the left eyes (31 of 48) had a mean OPP of 42 mm Hg or less.

Conclusions and Relevance  Significantly increased IOP and decreased OPP occur during HD, bringing both to levels that increase the risk of glaucoma development and progression. Clinicians should consider HD history in patients who have glaucoma progression, even when IOP has been well controlled. Such patients may benefit from IOP and blood pressure monitoring during HD sessions to minimize OPP changes resulting from IOP spikes and/or suboptimal blood pressure.

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Figure 1.
Average Ocular Pressure Readings During Hemodialysis

Mean arterial pressure (MAP), ocular perfusion pressure (OPP), systolic ocular perfusion pressure (SOPP), diastolic ocular perfusion pressure (DOPP), and mean ocular perfusion pressure (MOPP) in each eye at each point of measurement during hemodialysis. All measurements were taken with the patient in the seated position 15 minutes before starting hemodialysis (T1), 2 hours after starting hemodialysis (T2), and 15 minutes after ending hemodialysis (T3). L indicates left eye; and R, right eye.

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Figure 2.
Average Ocular Pressure Readings During Hemodialysis in Glaucomatous and Nonglaucomatous Eyes

Average ocular perfusion pressure (OPP) (A), mean OPP (MOPP) (B), systolic OPP (SOPP) (C), and diastolic OPP (DOPP) (D) of both eyes at each point of measurement during hemodialysis in glaucomatous and nonglaucomatous eyes. All measurements were taken with the patient in the seated position 15 minutes before starting hemodialysis (T1), 2 hours after starting hemodialysis (T2), and 15 minutes after ending hemodialysis (T3). L indicates left eye; and R, right eye.

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Figure 3.
Flowchart

Various factors affecting intraocular pressure (IOP) fluctuation during hemodialysis

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