Ocular Manifestations in Hemodialysis Patients: Importance of Ophthalmic Examination in Prevention of Ocular Sequels

Abstract

Background: Hemodialysis (HD)‑associated ocular abnormalities are one of the causes of morbidity among people undergoing HD. This study evaluates the frequency of ocular abnormalities in end‑stage
renal disease (ESRD) patients undergoing HD and their potential link to HD and demographic parameters.

Methods: This cross‑sectional study examined 242 eyes of 121 patients with ESRD undergoing regular HD after excluding the ineligible subjects. The study was designed in two parts. Medical histories of each patient including age, gender, family history, medication history, past
medical history, and duration of HD collected using a structured check list. All patients underwent complete ophthalmologic examination for evaluation of the best corrected visual acuity (BCVA), intraocular pressure (IOP), and anterior and posterior segments.

Results: In total, 121 patients, including 68 (56.2%) males and 53 (43.8%) females, were enrolled in the study. The mean ± SD age of the patients and their mean duration of dialysis were 51.59 ± 16.01 and 3.40 ± 2.75 years, respectively. The most prevalent etiology for HD was diabetes mellitus (39.67%), followed by hypertension (38.84%), and the most common ocular fndings included cataract (142 eyes; 58.7%) and ectopic calcifcation of the conjunctiva and cornea (78 eyes; %32.2). There was at least one abnormal ocular fnding in 89.3% of the cases. The BCVA was equal to or less than fnger count in 70 eyes (28.92%). There was a signifcant relationship between conjunctival calcifcation and the duration of dialysis (P = 0.02). There was signifcant association between etiology of HD and conjunctival calcifcation (adjusted odds ratio, 2.44; 95% CI, 1.05–5.67; and P value, 0.03). Such signifcant associations were present for corneal calcifcation (P = 0.009), cataract (P = 0.02), and
optic atrophy (P = 0.01).

Conclusions: Regular ophthalmologic examinations are recommended due
to the prevalence of clinical ocular abnormalities in HD patients.

Keywords: Diabetic retinopathy, eye disease, kidney disease, kidney failure, renal dialysis