The Influence of Hemodialysis on Ocular Pressure Dynamics: An Observational Study on IOP and OPP Changes
Year: 2025
Type: article
Study design: Observational Study
Abstract: progression of glaucomatous damage.The Early Manifest Glaucoma Trial reported that low baseline systolic perfusion pressure increased the hazard ratio for glaucoma development to 1.42.13 While previous studies have primarily assessed long-term OPP, the transient effects induced by HD remain poorly characterized.Patients with CKD frequently have compromised ocular blood flow, 14,15 and HD-induced fluctuations in IOP may exacerbate retinal or optic nerve ischemia, potentially leading to irreversible hypoxic damage.Despite decades of research, the effects of HD on IOP and OPP remain inconsistent.5,7,16,17 Some studies report transient IOP reductions due to decreased plasma osmolarity, whereas others note negligible changes.Similarly, the impact of intradialytic BP fluctuations on OPP is not well defined, underscoring the need for systematic evaluation. IntroductIonEnd-stage renal disease (ESRD) is a major contributor to global morbidity, mortality, and healthcare-related economic burden. 1 Chronic kidney disease (CKD), a precursor to ESRD, is a significant public health concern, with approximately 17% of the global CKD population residing in India. 2 A 2006 population-based study estimated the age-adjusted incidence of kidney failure in India at 232 per million population.3 By 2018, approximately 1,75,000 and 8,500 individuals were receiving hemodialysis (HD) and peritoneal dialysis (PD), respectively.4 Patients undergoing HD are at increased risk of glaucoma and other ocular complications.5 Changes in intraocular pressure (IOP) during HD are among the most commonly reported ophthalmological abnormalities in chronic HD patients.6,7 The effect of HD on IOP has been investigated for nearly six decades.Sitprija and Holmes first reported an increase in IOP during HD in 1962, 8 but subsequent studies have yielded variable results, with some observing IOP elevation 7,9 and others reporting a decrease or negligible change.7,10,11 Recent advances in dialysis techniques, including high-flux HD, hemofiltration, and improved urea control, may help maintain osmolar balance and prevent significant IOP elevations.7,12 These fluctuations are clinically relevant, particularly in patients with glaucoma, as sudden changes may compromise optic nerve function and vision.Ocular perfusion pressure (OPP), determined by systemic blood pressure (BP), is essential for maintaining adequate ocular tissue oxygenation.Abrupt reductions in OPP during HD can precipitate optic nerve ischemia, contributing to the development or 1-
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4417455232