TITLE:
Effect of Optimization of Hemodialysis on Ophthalmological Variables in Patients with End Stage Renal Disease
AUTHORS:
Nashaat Shawky Zaky, Eman Gamal Megahed, Sherein Mahmoud Hagras, Abd Elmonaem Abo Elfetoh Elhesy, Ahmed Mohamed Naguib Attiya, Salwa Mahmoud Elwasif, Mohamed Abdul Kader Sobh, Adel Elsayed Ellayeh
KEYWORDS:
Hemodialysis, Optimization, Tear Break Up Time, Ophthalmology
JOURNAL NAME:
Open Journal of Ophthalmology,
Vol.13 No.4,
November
27,
2023
ABSTRACT: Background: Conventional hemodialysis (HD) used in treating end stage renal
disease (ESRD) can result in multiorgan insult including the eye-owing to the
resultant reperfusion after the ischemic
event. Optimization of HD can be done using a process called remote ischemia
which includes applying cycles of brief, nonlethal ischemia followed by
reperfusion to one limb. This method sends signal to the end organs to
prepare themselves for the upcoming ischemia thus preventing their injury. Aim:
To evaluate the effect of remote ischemia preconditioning in HD on
ophthalmological variables. Patients and Methods: A pre-post interventional
analytical study conducted on patients receiving hemodialysis. Remote ischemia
preconditioning was done before each HD session incorporating 3 cycles of
alternating ischemia and reperfusion (5 minutes
each) performed in the upper limb using sphygmomanometer cuff. Ophthalmic
examination was done at baseline and 3 months after HD optimization. Assessment
was done half to one hour pre- and post-session for visual acuity, corneal,
conjunctival deposits, tear break up time (TBUT), anterior chamber depth and central macular thickness.
Results: The study included 50 eyes of 25 patients with almost equal gender
distribution and mean age of 37.52 ± 9.824 years. They were maintained on
hemodialysis for median 10 years (range 3-25 years). The commonest cause of
ESRD was hypertension. The studied ocular parameters showed insignificant
change after pre-conditioned HD except for TBUT that was statistically longer (p = 0.018). Conclusion: Optimization
of hemodialysis using remote ischemia does not seem to have significant ocular
effect apart from prolonged TBUT.