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.
References
[1]
Webster, A.C., Nagler, E.V., Morton, R.L. and Masson, P. (2017) Chronic Kidney Disease. The Lancet, 389, 1238-1252. https://doi.org/10.1016/S0140-6736(16)32064-5
[2]
Chen, H., Zhang, X. and Shen, X. (2018) Ocular Changes during Hemodialysis in Patients with End-Stage Renal Disease. BMC Ophthalmology, 18, Article No. 208. https://doi.org/10.1186/s12886-018-0885-0
[3]
Abdallah, A., Me, A., Gabr, A.F., Mahmoud, H.A. and Gamal, S.A. (2020) Effect of Hemodialysis on Intraocular Pressure. The Egyptian Journal of Hospital Medicine, 78, 212-219. https://doi.org/10.21608/ejhm.2020.69676
[4]
Sariyeva, A., Aydin, O. and Erol, H.A. (2021) Ocular Manifestations in Hemodialysis Patients and Short-Term Changes in Ophthalmologic Findings. Therapeutic Apheresis and Dialysis, 25, 204-210. https://doi.org/10.1111/1744-9987.13510
[5]
Bacci, M.R., Vasconcelos, L.Y., Murad, N., Chagas, A.C.P., Capuano, A.C., Alves, B.C., Pereira, E.C., Azzalis, L.A., Junqueira, V.B. and Fonseca, F. (2018) Remote Ischemic Preconditioning in Myocardial Protection in Hemodialysis Patients. International Journal of General Medicine, 11, 175-178. https://doi.org/10.2147/IJGM.S144385
[6]
Kal, Ö., Ulusoy, M.O., Kal, A., Tanriaşki, G. and Cezairlioğlu, Ş. (2018) Evaluation of Dry Eye Using Anterior Segment Optical Coherence Tomography in Patients with End-Stage Renal Disease Undergoing Hemodialysis. Therapeutic Apheresis and Dialysis, 22, 104-108. https://doi.org/10.1111/1744-9987.12612
[7]
Zhu, Q.J., Zhang, L., Lyu, S.Y., Cui, Z.J., Jiang, E.S. and Wang, J. (2022) Protective Limb Remote Ischemic Post-Conditioning against High-Intraocular-Pressure-In-duced Retinal Injury in Mice. International Journal of Ophthalmology, 15, 560-567. https://doi.org/10.18240/ijo.2022.04.06
[8]
Imbeault, B. and Nadeau-Fredette, A.C. (2019) Optimization of Dialysis Modality Transitions for Improved Patient Care. Canadian Journal of Kidney Health and Disease, 6, 205435811988266. https://doi.org/10.1177/2054358119882664
[9]
Bowman, B., Zheng, S., Yang, A., Schiller, B., Morfín, J.A., Seek, M. and Lockridge, R.S. (2018) Improving Incident ESRD Care via a Transitional Care Unit. American Journal of Kidney Diseases, 72, 278-283. https://doi.org/10.1053/j.ajkd.2018.01.035
[10]
Yang, Z., Tian, Y., Zhou, T., Zhu, Y., Zhang, P., Chen, J. and Li, J. (2022) Optimization of Dry Weight Assessment in Hemodialysis Patients via Reinforcement Learning. IEEE Journal of Biomedical and Health Informatics, 26, 4880-4891. https://doi.org/10.1109/JBHI.2022.3192021
[11]
Ohguro, N., Matsuda, M. and Fukuda, M. (1999) Corneal Endothelial Changes in Patients with Chronic Renal Failure. American Journal of Ophthalmology, 128, 234-236. https://doi.org/10.1016/S0002-9394(99)00086-0
[12]
Shiu, Y.T., Rotmans, J.I., Geelhoed, W.J., Pike, D.B. and Lee, T. (2019) Arteriovenous Conduits for Hemodialysis: How to Better Modulate the Pathophysiological Vascular Response to Optimize Vascular Access Durability. American Journal of Physiology-Renal Physiology, 316, F794-F806. https://doi.org/10.1152/ajprenal.00440.2018
[13]
Aktaş, S., Sağdık, H.M., Aktaş, H., Gülcan, E., Tetikoğlu, M., Coşgun, S., Çalışkan, S. and Özcura, F. (2015) Tear Function in Patients with Chronic Renal Failure Undergoing Hemodialysis. Renal Failure, 37, 245-248. https://doi.org/10.3109/0886022X.2014.982487
[14]
Hu, J., Bui, K.M., Patel, K.H., Kim, H., Arruda, J.A., Wilensky, J.T. and Vajaranant, T.S. (2013) Effect of Hemodialysis on Intraocular Pressure and Ocular Perfusion Pressure. JAMA Ophthalmology, 131, 1525-1531. https://doi.org/10.1001/jamaophthalmol.2013.5599
[15]
Ulaş, F., Doğan, ü., Keleş, A., Ertilav, M., Tekçe, H. and Celebi, S. (2013) Evaluation of Choroidal and Retinal Thickness Measurements Using Optical Coherence Tomography in Non-Diabetic Haemodialysis Patients. International Ophthalmology, 33, 533-539. https://doi.org/10.1007/s10792-013-9740-8
[16]
Dinc, U.A., Ozdek, S., Aktas, Z., Guz, G. and Onol, M. (2010) Changes in Intraocular Pressure, and Corneal and Retinal Nerve Fiber Layer Thickness during Hemodialysis. International Ophthalmology, 30, 337-340. https://doi.org/10.1007/s10792-009-9339-2
[17]
Ren, C., Wu, H., Li, D., Yang, Y., Gao, Y., et al. (2018) Remote Ischemic Conditioning Protects Diabetic Retinopathy in Streptozotocin-Induced Diabetic Rats via Anti-Inflammation and Antioxidation. Aging and Disease, 9, 1122-1133. https://doi.org/10.14336/AD.2018.0711
Nadeem, M., Kindelin, A., Mahady, L., Bhatia, K., Hoda, M.N., Ducruet, A.F. and Ahmad, S. (2021) Remote Ischemic Post-Conditioning Therapy Is Protective in Mouse Model of Traumatic Optic Neuropathy. NeuroMolecular Medicine, 23, 371-382. https://doi.org/10.1007/s12017-020-08631-1
[20]
El Dabagh, Y., Petersen, L., Pedersen, M. and Bek, T. (2019) Reduced Baseline Diameter and Contraction of Peripheral Retinal Arterioles Immediately after Remote Ischemia in Diabetic Patients. Graefe’s Archive for Clinical and Experimental Ophthalmology, 257, 2095-2101. https://doi.org/10.1007/s00417-019-04407-x
[21]
Pelit, A., Zümrütdal, A. and Akova, Y. (2003) The Effect of Hemodialysis on Visual Field Test in Patients with Chronic Renal Failure. Current Eye Research, 26, 303-306. https://doi.org/10.1076/ceyr.26.4.303.15425
[22]
Zhao, Y., Gan, L., Niu, Q., Ni, M. and Zuo, L. (2022) Efficacy and Safety of Expanded Hemodialysis in Hemodialysis Patients: A Meta-Analysis and Systematic Review. Renal Failure, 44, 541-550. https://doi.org/10.1080/0886022X.2022.2048855
