Hemodialysis May Affect Peripapillary Choroidal Thickness

Following hemodialysis, peripapillary choroidal thickness may significantly decrease in patients with end-stage kidney disease, suggesting that hemodialysis could influence the optic nerve head and surrounding structures, according to study results published in the Journal of Glaucoma.

The prevalence of eye disease is greater among people with chronic kidney disease (CKD) than people without CKD. The literature suggests that eyes and kidneys are interrelated, as they both have several common structural, developmental, and physiological pathways. Hemodynamic changes due to hemodialysis may result in changes to blood flow in the eye, investigators suggest, which in turn can affect structures such as the choroid. 

Although previous studies have assessed choroidal thickness outside of the macula, there are no reports on the effects of hemodialysis on peripapillary choroidal thickness. In addition, no studies have examined the association between hemodialysis  and choroidal thickness near the optic nerve. 

A team of investigators in Korea conducted a prospective observational study to determine the effects of hemodialysis on peripapillary choroidal thickness in patients with end-stage kidney disease undergoing hemodialysis by using swept-source optical coherence tomography (SS-OCT). They also assessed the association between changes in peripapillary choroidal thickness with other parameters. 

A total of 29 eyes from 29 patients (17 women; mean age, 55.7±10.4 years) were included in the analysis. After hemodialysis, the mean body weight decreased from 62.5±10.9 kg to 59.9±11.0 kg (P <.001) and the systolic blood pressure decreased from 151.2±31.6 mm Hg to 140.4±28.8 mm Hg (P =.016). 

On measuring peripapillary and macular parameters via SS-OCT before and after hemodialysis, the mean peripapillary retinal nerve fiber layer thickness increased significantly from 96.8±15.2 μm to 99.4±15.1 μm (P <.001) and the mean peripapillary choroidal thickness significantly decreased from 127.3±49.2 μm to 117.1±50.9 μm (P <.001).

After hemodialysis, peripapillary choroidal thickness decreased significantly in all directions and although not significantly, peripapillary retinal nerve fiber layer thickness also decreased in all directions. In addition, macular parameters such as ganglion cell thickness, ganglion cell-inner plexiform layer thickness, and macular choroidal thickness significantly increased after hemodialysis (P =.003, P =.001, and P <.001, respectively). 

Assessing the correlation between changes in peripapillary choroidal thickness and other parameters suggested that of the changes in the optical coherence tomography parameters, only macular choroidal thickness and peripapillary retinal nerve fiber layer thickness were associated with significant changes in peripapillary choroidal thickness; however, macular choroidal thickness was positively correlated (p=0.547, P =.002), while peripapillary retinal nerve fiber layer thickness was negatively correlated (p= −0.470, P =.010).

“We observed a significant decrease in [peripapillary choroidal thickness] after [hemodialysis],” report the research team. “Our results suggest that [hemodialysis] can influence the [optic nerve head] and its surrounding structures.”

Reference 

Lee WJ, Hong R, Kang MH, et al. Effect of hemodialysis on peripapillary choroidal thickness measured by swept-source optical coherence tomography. J Glaucoma. 2021;30(6):459-464. doi:10.1097/IJG.0000000000001762