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Corneal disease in patients with chronic renal insufficiency undergoing hemodialysis
P Diaz-Couchoud1, F D Bordas, J R Garcia
1Ophthalmology Service, Hospital Clinic i Provincial, C/Enric Granados 45 pral 2, 08008 Barcelona, Spain. 26767pdc@comb.es
Insights
Hemodialysis patients showed reduced corneal endothelium cell density, linked to dialysis duration, not blood elements. This suggests other factors may cause endothelial changes in these patients.
Area of Science:
- Ophthalmology
- Nephrology
- Cell Biology
Background:
- Renal insufficiency necessitates hemodialysis, a treatment that may impact ocular health.
- The corneal endothelium is crucial for maintaining corneal clarity and function.
- Previous research has not fully elucidated the specific effects of hemodialysis on the corneal endothelium.
Purpose of the Study:
- To investigate alterations in the corneal endothelium of patients undergoing hemodialysis.
- To determine if factors like dialysis duration, aluminum, calcium-phosphate product, or parathyroid hormone levels influence these changes.
- To assess the presence of iron and aluminum in the aqueous humor.
Main Methods:
- Ophthalmologic examinations, including pachymetry and specular microscopy, were performed on 66 hemodialysis patients.
- Patients were stratified based on dialysis duration and specific blood markers.
- Aqueous humor analysis was conducted to quantify iron and aluminum levels.
Main Results:
- No significant corneal edema was observed in hemodialysis patients.
- Corneal endothelial cell density was significantly lower in hemodialysis patients compared to controls.
- This reduction correlated with the duration of dialysis but not with serum aluminum or calcium levels.
Conclusions:
- Hemodialysis is associated with a reduction in corneal endothelial cell density, potentially linked to dialysis duration.
- The observed endothelial alterations are not directly related to serum aluminum, calcium, or iron levels in the aqueous humor.
- Other unidentified factors or pre-existing anterior segment abnormalities may contribute to these ocular changes.
Purpose:
To evaluate alterations of the corneal endothelium in patients undergoing hemodialysis for renal insufficiency.
Methods:
Sixty-six patients undergoing hemodialysis received a complete ophthalmologic examination. The state of the endothelium was assessed using pachymetry and specular microscopy. The group of patients undergoing dialysis was divided according to the time of dialysis, aluminum, product of calcium and phosphate in blood, and parathyroid hormone to analyze the influence of these factors. The possible presence of iron and aluminum in the aqueous humor of patients who underwent and those who did not undergo hemodialysis was also estimated.
Results:
Patients undergoing hemodialysis did not have significant corneal edema. Cell density was significantly lower in patients undergoing dialysis than in patients not undergoing dialysis; this reduction appeared to be associated with length of dialysis and was unrelated to serum aluminum and calcium levels. Patients undergoing dialysis did not have cell polymorphism or polymegethism, although there was a tendency toward increased polymegethism with length of dialysis. Aluminum and iron were not increased in the aqueous humor of patients undergoing dialysis.
Conclusions:
The alteration of the endothelium that we found is not related to the elements studied. It is possibly the result of another product dissolved in the anterior chamber or to the alterations of the anterior segment that these patients are known to have.