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Conjunctival and corneal calcification. a In patient A, who had a 7-year HD history, a gray, line-shaped calcium deposit could be seen on the cornea. b In patient B, who had a 3-year HD history, white dot- and line-shaped calcium deposits were observed at the limbus. c In patient C, who had a 6-year HD history, white, block-shaped conjunctival calcium deposits were observed
Source publication
Background:
To explore ocular changes during hemodialysis (HD) in chronic renal failure patients and to determine the effects of different causes of renal failure during HD.
Methods:
A total of 90 eyes from 45 end-stage renal disease (ESRD) patients undergoing HD were evaluated in this study. All ophthalmological examinations were conducted with...
Citations
... Согласно последним данным зарубежных исследований, структурные изменения органа зрения, связанные с уремической офтальмопатией, наблюдаются у всех пациентов с ХПН [4]. Одним из наиболее известных офтальмологических проявлений уремии является альбуминурическая ретинопатия, описанная Гельмгольцем, которая характеризуется кровоизлияниями глазного дна, двусторонней отслойкой сетчатки, типичными ватообразными очагами и образованием «фигуры звезды» в области желтого пятна. ...
Цель. Определение степени нейродегенеративных процессов в сетчатке путем оценки динамики снижения толщины pRNFL у пациентов с терминальной стадией хронической почечной недостаточности (ХПН) недиабетического генеза, получающих гемодиализ. Материалы и методы. Исследование степени нейродегенерации в сетчатке проводилось на основании динамики снижения толщины pRNFL в течение 2-летнего периода наблюдения у пациентов с терминальной стадией ХПН, которые регулярно получали гемодиализ. На основании критериев отбора была сформирована выборка из 81 пациента (162 глаза). В качестве контрольной группы была также отобрана однородная по полу и возрасту выборка из 30 здоровых лиц (60 глаз). Исследование проводилось на устройстве DRI OCT Triton и включало расчет коэффициента регрессии (B), доверительного интервала (Cl), а также определение коэффициента линейной регрессии для выявления значимости факторов, влияющих на степень истончения pRNFL у пациентов. Результаты. В группе пациентов с терминальной стадией ХПН в течение 2-летнего периода наблюдения отмечалось статистически достоверное (p<0,05) снижение показателя толщины pRNFL, которое было подтверждено результатами расчета показателей коэффициента регрессии (B) и доверительного интервала (Cl). Наиболее выраженное истончение слоя pRNFL было выявлено в верхнем и нижнем назальных секторах, а также в нижне-темпоральном секторе у пациентов с терминальной стадией ХПН. Наиболее значимым фактором, влияющим на динамику снижения толщины pRNFL у пациентов основной группы, являлся показатель скорости клубочковой фильтрации (СКФ), главным образом характеризующий тяжесть ХПН. Заключение. У пациентов с терминальной стадией ХПН недиабетического генеза, получающих гемодиализ, имел место значительно ускоренный темп снижения толщины pRNFL по сравнению со здоровыми пациентами контрольной группы. Наличие у пациентов тяжелой формы ХПН, выражавшейся в сниженном показателе СКФ, обусловило более быстрое снижение толщины pRNFL.
Purpose. Assessment of the degree of neurodegenerative processes in the retina by evaluating the dynamics of peripapillary retinal nerve fiber layer (pRNFL) thickness in patients with end-stage non-diabetic chronic kidney disease (CKD) undergoing hemodialysis. Materials and Methods. The study of neurodegeneration in the retina was based on the dynamics of peripapillary retinal nerve fiber layer (pRNFL) thickness over a 2-year observation period in patients with end-stage CKD regularly undergoing hemodialysis. A sample of 81 patients (162 eyes) was selected based on inclusion criteria, and a control group of 30 healthy individuals (60 eyes) matched for gender and age was also chosen. The study was conducted using the DRI OCT Triton device (Topcon). The investigation included the calculation of the regression coefficient (B), confidence interval (CI), and determination of the linear regression coefficient to assess the significance of factors influencing the degree of pRNFL thinning in patients. Results. In the group of patients with end-stage CKD, a statistically significant (p<0.05) decrease in pRNFL thickness was observed over the 2-year observation period, as confirmed by the results of the regression coefficient (B) and confidence interval (CI) calculations. The most pronounced thinning of the pRNFL layer was identified in the upper and lower nasal sectors, as well as the lower temporal sector in patients with end- stage CKD. The most significant factor influencing the pRNFL dynamics in the main group was the glomerular filtration rate (GFR), primarily indicative of the severity of CKD. Conclusion. Non-diabetic patients with end-stage CKD undergoing hemodialysis experienced a significantly faster rate of pRNFL loss compared to healthy individuals in the control group. The presence of more severe CKD, reflected in a lower GFR, was associated with a more rapid loss of pRNFL in CKD patients.
... The way that the retina reacts to a single HD session is not obvious, and the studies give contradictory results, from RT decrease through no changes to RT thickness increase [6,7,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. ...
... Only two studies assessed the reaction of selected retinal layers to HD sessions [12,13]. Changes in systemic parameters resulting from HD session and their impact on RT and pRNFL thickness changes were described only in several studies [13][14][15][16][17]. ...
... However, a significant number of studies indicate no effect of an HD session on RT or even a decrease in RT after HD [6,12,13,[16][17][18][19][20][21][22][23]25,26]. The differences may be due to small groups of subjects, methodological differences between studies, differences in the OCT types used, and differences in the groups of subjects themselves, including age, gender, axial length, refraction, or ethnic origin, all of which influence the retinal, GCL and pRNFL thickness [6,7,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]30]. The aetiology of CKD in the studied patients subjected to HD may be of particular importance with respect to differences in the obtained results. ...
Abstract
Background: The aim of the study was to assess the influence of a single haemodialysis (HD) session on the retinal and optic nerve morphology in end-stage kidney disease (ESKD) patients. Methods: It is a prospective study including only the right eye of 35 chronic kidney disease (CKD) patients subjected to HD. Each patient underwent a full eye examination 30 min before HD (8 a.m.) and 15 min after HD. Optical coherence tomography (OCT) was used to assess the peripapillary retinal nerve fibre layer (pRNFL) thickness, macular nerve fibre layer (mRNFL) thickness, ganglion cell layer with inner plexiform layer thickness (GCL+), GCL++ (mRNFL and GCL+) thickness, total retinal thickness (RT) and total macular volume (TMV). The correlation was tested between such systemic parameters changes as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), body weight, plasma osmolarity and ocular perfusion pressure (OPP) and ultrafiltration volume with total RT and pRNFL thickness changes during HD. Results: In the results of a single HD session, we could observe a statistically significant increase in the total RT thickness (pre-HD 270.4 ± 19.94 μm, post-HD 272.14 ± 20.11 μm; p = 0.0014), TMV (pre-HD 7.48 ± 0.53 mm3, post-HD 7.52 ± 0.55 mm3; p = 0.0006), total pRNFL thickness (pre-HD 97.46 ± 15.71 μm, post-HD 100.23 ± 14.7 μm; p = 0.0039), total GCL+ thickness (pre-HD 70.11 ± 9.24 μm, post-HD 70.6 ± 9.7 μm; p = 0.0044), and GCL++ thickness (pre-HD 97.46 ± 12.56 μm, post-HD 97.9 ± 12.94 μm; p = 0.0081). We observed a significant correlation between the change in total RT and DBP change, as well as between body weight change and the change in total pRNFL thickness. There was also a correlation between total pRNFL thickness change and the presence of diabetes mellitus. Conclusion: Even a single HD session affects the retinal and pRNFL thickness, which should be taken into account when interpreting the OCT results in patients subjected to HD. The impact of changes after a single HD session on selected parameters requires further assessment in subsequent studies, including long-term observation.
Keywords: retinal thickness; haemodialysis; optical coherence tomography Diagnostics 2024, 14, 331. Full text link: https://www.mdpi.com/2075-4418/14/3/331
... It is well known that CT depends on age and gender [44]. A significant majority of the studies concern Asian populations [4,[9][10][11][12]14,15,[18][19][20][22][23][24], and racial differences may play a significant role [45]. The study groups differ in terms of the assessed CKD aetiology, which is definitely influenced by ethnicity [46]. ...
... It is also worth considering the exclusion criteria-some studies excluded patients after eye surgery or who were smokers due to the influence of these factors on the CT [14]. The adjustment of the results for diurnal variation of the CT also differed between studies, and in some studies, the diurnal variation was not considered [4,10,12,14,18,20,23], despite the fact that it affects CT [48]. The studies also differ in terms of the time for which the patients have been subjected to HD, with single studies assessing patients undergoing their first HD session [11], which may also be of importance, as the duration of the HD may affect the microcirculatory response [38]. ...
... The subgroups are quite small, which significantly limits the value of the obtained results. Nevertheless, in the case of most parameters, the changes followed a similar trend, yet, lower best-corrected visual acuity, increased central corneal thickness, and decreased CT and RNFL thickness were observed in diabetic kidney disease [10]. ∆ Choroid central thickness 25 (10-57) significant reduction p < 0.001 In the study by Kang et al., DM was the only factor significantly correlated with SCT differences observed after HD sessions [24]. ...
Haemodialysis (HD) is currently the most commonly used method of renal replacement therapy. The process of dialysis involves numerous changes that affect many systems, including the eye. The changes occurring in the course of HD may affect the ocular parameters, such as intraocular pressure, central corneal thickness, retinal thickness, retinal nerve fibre layer thickness, and choroidal thickness (CT). The choroid, being one of the most vascularized tissues, is characterized by the highest ratio of blood flow to tissue volume in the entire body, may be particularly susceptible to changes occurring during HD, and at the same time reflect the microcirculatory status and its response to HD. Patients with end-stage renal disease subjected to dialysis are highly susceptible to systemic microvascular dysfunction. Moreover, it is considered that the process of HD itself contributes to vascular dysfunction. Nowadays, thanks to the development of imaging techniques, the widely available optical coherence tomography (OCT) tests allow for the assessment of CT, while OCT-angiography allows for a quick, non-invasive, and repeatable assessment of the condition of retinal and choroidal microcirculation, which significantly expands our knowledge regarding the reaction of ocular microcirculation due to HD. The assessment of both retinal and choroidal circulation is even more attractive because retinal circulation is autoregulated, while choroidal circulation is mainly controlled by extrinsic autonomic innervation. Thus, assessment of the choroidal response to an HD session may provide the possibility to indirectly evaluate the functions of the autonomic system in patients subjected to HD. At a time when the importance of microcirculation in systemic and renal diseases is becoming increasingly evident, the assessment of ocular microcirculation appears to be a potential biomarker for assessing the condition of systemic microcirculation. In this work, we present a review of the literature on the effect of the HD session on CT and the retinal and choroidal microcirculation.
... Penelitian lain melaporkan karakteristik demografi pasien hemodialisis, termasuk jenis kelamin. Studi tersebut menemukan bahwa 60% mata yang diperiksa adalah lakilaki dan 40% adalah perempuan (Chen et al., 2018). Menurut National Kidney Foundation, pria memiliki peningkatan risiko gagal ginjal dibandingkan wanita. ...
... Responden pada kegiatan pengabdian masyarakat mayoritas terdiri dari kelompok usia produktif (82%), dan kelompok usia non produktif (18%). Sebuah penelitian menemukan tidak ada perbedaan usia yang signifikan di antara tiga subkelompok pasien hemodialisis dengan perubahan mata (Chen et al., 2018). Penelitian lain melaporkan rentang usia pasien hemodialisis dengan kelainan mata yaitu 45-70 tahun (Kianersi et al., 2019). ...
karena pasien dengan penyakit ginjal kronis dan gagal ginjal terminal yang menjalani hemodialisis memiliki risiko yang lebih tinggi untuk mengalami kelainan mata. Maka dari itu kegiatan ini bertujuan untuk meningkatkan kesadaran masyarakat akan pentingnya menjaga kesehatan mata dan melakukan pemeriksaan mata secara rutin. Metode, Pengabdian masyarakat yang dilaksanakan pada bulan Juni 2023 ini dihadiri oleh 185 peserta dari pasien Hemodialisa di RSI Jemursari Surabaya. Kegiatan pengabdian masyarakat yang dilakukan berupa pemberian edukasi terkait kesehatan mata pada pasien HD, seberapa penting dan berisiko terjadi kelainana mata, Pemberian layanan pemeriksaan mata geratis pada pasien HD serta pemberian konsultasi mata gratis pada pasien HD. Penelitian ini dilakukan secara observasional deskriptif. Hasil dan Pembahasan, Pengabdian masyarakat berupa pemeriksaan mata pada Pasien Hemodialisa di RSI Jemursari Surabaya sebagian besar dilakukan pada pasien dengan jenis kelamin laki-laki (62%). Responden mayoritas terdiri dari kelompok usia produktif (82%), dan kelompok usia non produktif (18%). Kesimpulan, Pemeriksaan mata pada pasien hemodialisa RSI Jemursari Surabaya terdiri dari jenis kelamin laki-laki (62%) dan kelompok usia produktif (82%). Diperlukan penelitian lebih lanjut untuk mengetahui faktor risiko yang menyertai serta analisis anaitik lebih lanjut.
... Several publications have studied ocular effects of HD for ESKD. Dry eye, increase of corneal thickness and intraocular pressure have been described [2,3]. Decrease of choroidal thickness after HD has also been reported in several studies [2][3][4][5][6][7][8] with a more significant decrease in diabetic patients [4][5][6] supporting the hypothesis of a an underlying choroidopathy in diabetic eyes. ...
... Dry eye, increase of corneal thickness and intraocular pressure have been described [2,3]. Decrease of choroidal thickness after HD has also been reported in several studies [2][3][4][5][6][7][8] with a more significant decrease in diabetic patients [4][5][6] supporting the hypothesis of a an underlying choroidopathy in diabetic eyes. Nakano et al. [5] recently analysed the choroidal vessel lumen on binarized enhanced-depth imaging optical coherence tomography (EDI-OCT) which significantly decreased for diabetic patients in comparison to non-diabetic patients. ...
... Several studies analysed ocular changes following HD session with variable findings [2-6, 10-12] but until now, a single study using OCTA for retinal and choroidal vascular variations has been published [9]. In our study, the SCT on EDI-OCT significantly decreased (p = 0.003) after HD for ESKD as widely reported by other studies [2][3][4][5][6][7]. In contrast to Chang et al. [4] no significant correlation between SCT reduction and loss of weight has been found in our study. ...
Purpose
To study effects of hemodialysis (HD) on retinal and choroidal vasculature in patients with end-stage kidney disease (ESKD) using optical coherence tomography angiography (OCTA).
Methods
In this prospective study, we investigated eyes of patients undergoing hemodialysis for ESKD from Mondor University Hospital. Only one eye/patient was considered. Subfoveal choroidal thickness (SCT) was measured on enhanced-depth imaging optical coherence tomography (EDI-OCT) before and after the hemodialysis session. OCTA was used to extract retinal vascular density (superficial and deep capillary plexus, SCP, DCP) and choriocapillaris non-perfusion. Clinical, demographic and biological parameters (Blood B-Nitric Peptid rate prior to HD session) were reviewed.
Results
Twenty patients (mean age 53.2 ± 13.6 years, 10 males and 10 females) were included in this prospective study. SCT significantly decreased after the HD session (234.3 ± 56.14 µm before HD to 211.9 ± 60.79 µm after hemodialysis (Wilcoxon signed-rank test, p = 0.003)). Non-perfusion in the choriocapillaris significantly increased after HD (41.65 ± 3.58 before HD, 42.95 ± 3.19 after HD, p = 0.036) while no significant modification of the vascular density was observed in the retinal vasculature (SCP, DCP) around the macular zone or the optic nerve. An increased plasma B-Nitric Peptide (BNP) level prior to the onset of the HD session was significantly correlated with the decrease of the SCT (r = 0.45, p = 0.043).
Conclusion
Hemodialysis in patients with ESKD is associated with a significant decrease in SCT and an increase in non-perfusion in the choriocapillaris on OCTA. A High BNP level prior to the onset of the hemodialysis appears to be correlated with the decrease in SCT.
... There were 22 full-text articles assessed for eligibility, from which we excluded seven trials based on the following: (1) optical coherence tomography angiography (OCTA) studies (n = 2), (2) only processed OCT once (n = 1), (3) did not provide SCT data (n = 4). Ultimately, a total of 15 articles were included in our study [13,15,[19][20][21][22][23][24][25][26][27][28][29][30][31], and their characteristics are presented in Table 1. The complementary characteristics of relevant data on DR severity and previous treatments are presented in Supplementary Material Table 1. ...
Introduction:
Hemodialysis (HD) has various effects on the body, including optimizing body fluid composition and volume, which may have an impact on subfoveal choroidal thickness (SCT) in individuals with end-stage kidney disease (ESKD). However, previous studies have produced conflicting results regarding the effect of HD on SCT in patients with ESKD. Therefore, we conducted a meta-analysis to investigate the influence of HD on SCT.
Methods:
A comprehensive search of relevant studies and bibliographies was conducted using Embase, PubMed, and Web of Science databases up to September 2022. Weighted mean difference (WMD) and 95% confidence interval (CI) were used to summarize the SCT change. Heterogeneity and publication bias were assessed, and a random-effects model was employed for the meta-analysis. Subgroup analyses were also performed to evaluate the influence of factors such as diabetes mellitus (DM), the severity of diabetic retinopathy (DR), diurnal variation adjustment, optical coherence tomography (OCT) types, and OCT scan modes.
Results:
A total of 15 studies involving 1010 eyes were eligible for this meta-analysis, including 552 diabetic eyes, 230 non-diabetic eyes, and the remaining 228 eyes were uncategorized. The meta-analysis revealed a significant reduction in SCT after HD (WMD = -13.66 μm; 95% CI -24.29 to -3.03 μm; z = -5.115, P < 0.0001). Subgroup analysis indicated a significant difference between the DM and non-DM groups (WMD = -24.10 μm vs. -15.37 μm, 95% CI -27.39 to -20.80 μm vs. -19.07 to -11.66 μm; P = 0.001). Additionally, the group with proliferative diabetic retinopathy (PDR) exhibited a more pronounced reduction in SCT (WMD = -28.66 μm; 95% CI -37.10 to -20.23; z = -6.660, P < 0.0001). Adjusting for diurnal variation, different types or scan modes of OCT did not significantly affect the results.
Conclusion:
HD leads to a significant decrease in SCT among patients with ESKD, especially in patients with DM with PDR.
... Ранее ряд авторов провели исследования, посвященные изучению офтальмологических показателей у пациентов, получающих гемодиализ. Так было выявлено, что на фоне диализной терапии происходит изменение уровня внутриглазного давления [6], толщины сетчатой [7] и сосудистой оболочки [8], перфузии хориокапилляров [9] и остроты зрения [10,11]. Однако данные работы включали пациентов различной этиологии тХПН в том числе недиабетического генеза, не имеющих диабетической ретинопатии (ДР). ...
Introduction . Kidney and pancreas transplantation is a surgical method for the treatment of patients with diabetes mellitus and terminal diabetic nephropathy. While waiting for surgical treatment, potential recipients receive maintenance hemodialysis. Dialysis initiates the loss of body fluid, which in turn can affect the state of the intraocular structures. Aim . To study the effect of long-term hemodialysis therapy on ophthalmic parameters in patients with terminal diabetic nephropathy. Material and methods . Sixty patients (120 eyes) were examined: group A included 30 patients with end-stage renal failure as a result of diabetic nephropathy, group B included 30 people without systemic and ocular pathologies. The ophthalmological status of group A was assessed at the stage of planned preparation for renal replacement therapy, at 3 and 6 months after the initiation of dialysis. Ophthalmological examination consisted of the use of traditional and special diagnostic methods (microperimetry, photorecording of the fundus, optical coherence tomography angiography). Results . Within 6 months of hemodialysis courses, the following was recorded: a decrease in the thickness of the retina (Me: from 348.5 to 306.1 µm; p <0.05) and choroid (Me: from 330.3 to 294.9 µm; p <0.05), the improvement of retinal perfusion in eyes with diabetic macular edema (Me in the superficial capillary plexus: from 10.6 to 15.8% in the fovea, from 19.7 to 25.4% in the parafovea; in the deep capillary plexus: from 15.4 to 20.9% in the fovea, from 27.5 to 33.5% in the parafovea; p <0.05), a decrease in choroidal hemoperfusion (Me in the layer of choriocapillaries: from 59.0 to 54.2% in the fovea, from 59.3 to 54.7% in the parafovea; in the deep layer of the choroids: from 55.5 to 50.7% in the fovea, from 55.3 to 50.7% in the parafovea; p<0.05),an improvement in retinal photosensitivity (Me: from 16.7 to 20.3 dB in eyes with diabetic macular edema; from 21.1 to 24.2 dB in eyes without diabetic macular edema; p<0.05) and increased visual acuity in eyes with macular edema (Me: 0.1 to 0.3; p<0.05). Conclusions . Against the background of maintenance hemodialysis hemodialysis in patients with terminal diabetic nephropathy, along with a decrease in hyperazotemia, there is an improvement in architectonics, hemodynamics of the retina and visual functions.
... H. Chen и соавт. [8] кальцификацию слизистой оболочки в сочетании с ее гиперемией диагностировали в 48,89 % случаев, а Z. Aktas и соавт. [9] -в 1,6 раза чаще (81,3 %). ...
... [9] -в 1,6 раза чаще (81,3 %). Отложения располагались с носовой и/или височной стороны конъюнктивы, роговицы и лимба; были белыми или серыми, имели форму точек, линий или блоков [8]. В другом исследовании роговично-конъюнктивальные кальцинаты были выявлены лишь у 14 % пациентов и, по данным авторов, с содержанием паратиреоидного гормона, уровнем фосфора и кальция не коррелировали [10]. ...
... У больных тХПН, получающих программный ГД, нередко диагностируют ССГ. Установлено, что сеанс диализа индуцирует уменьшение времени разрыва слезной пленки, снижение базальной секреции слезы, способствует усилению кератоэпителиопатии, в ряде случаев обусловливающей понижение остроты зрения [6,8,9,[11][12][13][14]. Данные изменения находятся в связи с интрадиализным повышением коллоидно-осмотического давления плазмы крови [11]. ...
The literature review discusses the impact of scheduled hemodialysis on the state of the anterior part of the eye, the chorioretinal complex, the central and peripheral vision. The hemodialysis procedure is accompanied by a decrease in basal tear production, quickening of the tear film break-up, and an abnormal ocular surface disease index. Thinning of the corneal center is not accompanied by significant keratometric changes. Intradialytic thinning of the choroid and reduction of ocular perfusion pressure may be involved in the progression of ischemic eye diseases. Lower visual acuity is associated with the instability of the lens and choroid thickness. The impact of hemodialysis on the peripheral vision has not been sufficiently investigated. The correlations of ophthalmic changes with systemic effects of the dialysis are ambiguous. The inconsistency of the research results requires that the research should be continued.
... End-Stage Renal Disease (ESRD) is characterized by a glomerular filtration rate of <15 ml/min. At this stage, various clinical manifestations such as hypertension, anemia, edema, metabolic disorders, and endocrine disorders may occur that require renal replacement therapy such as hemodialysis (HD) (1). ...
Purpose
This study aimed to determine the effects of a nurse-led structured home visit program on quality of life and adherence to treatment in patients undergoing hemodialysis.
Methods
The study was quasi-experimental research in which 62 hemodialysis patients referred to Bu Ali hospital in Ardabil participated in two groups: Intervention (n = 31) and control (n = 31). The intervention included a structured and planned home visit program that was performed in five stages over 3 months. Data collection tools were a demographic information form, Kidney Disease Quality of Life Short Form (KDQOL–SF™) and End Stage Renal Disease Adherence Questionnaire (ESRD_AQ) which were completed by patients before, at the end of the first, second, and third month of intervention. SPSS v20 software and descriptive and analytical tests (Chi-square, t-test, ANOVA and repeated measure) were used for data analysis.
Findings
Examining demographic characteristics showed that there is a negative and significant relationship between age and quality of life scores (P = 0.004), that is, with increasing age, the quality of life score decreases, but other demographic characteristics did not have a significant relationship with quality of life scores and adherence to treatment (P > 0.05).
Also, the results showed that in the intervention and control groups, during the study, the scores of quality of life and adherence to treatment increased significantly, and this increase was significantly higher in the intervention group than in the control group (P < 0.001).
The scores of quality of life and adherence to treatment increased significantly both during the study in each group separately and between groups during the study (P < 0.001).
Conclusions
According to the significant improvement in quality of life and adherence to treatment in patients following a home-visiting program during 3 months, these interventions can be utilized to improve quality of life and adherence to treatment of patients undergoing hemodialysis.
Practice implications
Home visiting programs significantly improve the level of knowledge of patients undergoing hemodialysis and their family members, through their involvement in the care process. Having said that, it seems plausible to implement home visits in the standard care plans of hemodialysis patients.
... Ocular effects of HD can vary significantly, ranging from dry eye, corneal erosion, band keratopathy, perilimbal calcium deposits, posterior subcapsular cataract, intraocular pressure (IOP) changes, thickness changes in the central cornea (CCT), retinal nerve fiber layer, and choroid to retinal hemorrhage, retinal detachment, and macular edema. Best corrected visual acuity (BCVA) increases following a single HD session [2] [3] [4]. ...
... Till now, there is no solid consensus regarding the effect of HD on the IOP. Studies suggest that changes in the measured IOP might be related to the measurement method used, anterior chamber depth, as well as the blood pressure [2]. The IOP in the current cohort did not vary significantly from the baseline measured values. ...
... Our results showed insignificant decrease in CMT and RNFL. In contrast to these results, Chen et al., [2] in their study noticed statistically significant increase in the previous parameters and presumed that reduction in the plasma crystal osmotic pressure during HD drives the fluids into the retinal layers along the concentration gradient causing retinal edema. In a study by Manaviat et al., [17] remote ischemia was performed for 40 diabetic patients with macular edema before receiving standard treatment and were compared to 40 control pa-tients. ...
