Ocular Changes During Hemodialysis In Patients With Chronic Renal Failure

Purpose: To explore ocular changes during hemodialysis in chronic renal failure patients,and to determine influences of different causes of renal failure during hemodialysis.With findings of the basic factors that affect these changes,scientific eye protection advice can be provided to renal failure patients before and after hemodialysis.Method: A total of 90 eyes from 45 chronic renal failure patients undergoing hemodialysis at Blood Purification Center of Ruijin Hospital Affiliated to Shanghai Jiao Tong University collected from February 2014 to October 2014 were enrolled in this study,and 94 eyes from 47 normal people were enrolled as the control group.A comprehensive eye examination,including computer optometry,best corrected visual acuity,dry eye tests,intraocular pressure,biological measurement of anterior chamber,cornea,lens,retina and choroid were done for the hemodialysis group within an hour before and after a single hemodialysis session,while the control group received once the same exams.Then the hemodialysis patients were divided into the primary kidney disease subgroup,the hypertensive kidney disease subgroup,and the diabetic nephropathy subgroup according to the primary etiology of renal failure.Blood pressure,renal function,blood electrolytes and other parameters were collected from all patients.Data were statistically analyzed by independent sample t test,paired t test,single factor analysis of variance,least significant difference test,and multiple linear regression analysis.Result: Except from the thickness of retina in some regions(A4,A5)and conjunctival and corneal calcification,no significant differences were found between the hemodialysis group and the control group.After hemodialysis,the mean tear break?up time reduced from(7.603 ± 6.502)seconds to(5.852 ± 5.681)seconds,P = 0.003;Schirmer's I test result fell from(12.056 ± 8.762)mm to(10.006 ± 7.721)mm,P = 0.010;the average intraocular pressure decreased from(12.77 ± 2.67)mm Hg to(12.21 ± 2.41)mm Hg,P = 0.034;the mean anterior chamber depth fell from(2.630 ± 0.458)mm to(2.601 ± 0.516)mm,P = 0.034;the mean lens thickness was(4.153 ± 0.413)mm before hemodialysis and(4.056 ± 0.389)mm after hemodialysis,P was less than 0.001;the average PNS grading rose from(0.6067 ± 0.7009)to(0.7079 ± 0.7262),P = 0.019;the average retinal thickness increased in A3,A4,A6,A7 regions,P was less than 0.05;the mean retinal nerve fiber layer thickness was(94.20 ± 14.00)?m before hemodialysis vs(96.54 ± 14.78)?m after hemodialysis,P = 0.003;the mean choroidal thickness decreased from(276.26 ± 76.84)?m before hemodialysis to(240.84 ± 69.38)?m after hemodialysis,P was less than 0.001;no significant difference were noticed in the rest of the ophthalmology parameters during hemodialysis.Renal failure patients of different causes shared the same trend in changes of optic parameters during hemodialysis.The accuracy of the predictive equations of intraocular pressure,tear break?up time,Schirmer's I test,retinal thickness and volume,and choroidal thickness was proved.Conclusion: Hemodialysis may affect the full range of eye conditions in renal failure patients.Dry eye,conjunctival and corneal calcification deposits,intraocular pressure changes,retinal and choroidal thickness are the most obvious changes.Different etiologies tends to have same trend in ocular parameters change during hemodialysis.Intraocular pressure and other parameters before hemodialysis patients can be used to predict some of the key parameters of eye changes after hemodialysis,which can be of important clinical significance for post?hemodialysis eye protection.