Haemodialysis-Induced Stress Influences Ocular Microcirculation

Area of Science:

• Ophthalmology
• Nephrology
• Cardiovascular Medicine

Background:

• Hemodialysis (HD) imposes circulatory stress, potentially causing endothelial dysfunction and multiorgan issues.
• Retinal and choroidal microcirculation may be affected by HD-induced circulatory stress.
• Endothelial dysfunction is a key factor in hemodialysis-associated complications.

Purpose of the Study:

• To assess the impact of a single hemodialysis session on retinal and choroidal microcirculation.
• To evaluate changes in optical coherence tomography angiography (OCTA) parameters post-hemodialysis.
• To correlate microcirculatory changes with biochemical modulators of endothelial function.

Main Methods:

• Optical coherence tomography angiography (OCTA) was used to measure vessel density (VD) in retinal and choroidal layers before and after hemodialysis in 35 patients.
• Retinal thickness (RT) and choroidal thickness (CT) were measured.
• Blood levels of asymmetric dimethylarginine (ADMA), endothelin-1 (ET-1), malondialdehyde (MDA), and oxidative stress markers were assessed pre- and post-hemodialysis.

Main Results:

• A single hemodialysis session significantly increased retinal thickness and decreased choroidal thickness.
• Hemodialysis led to increased oxidative and osmotic stress, elevated ET-1, and decreased ADMA levels.
• Biochemical changes correlated with alterations in retinal and choroidal thickness and vessel density, with ET-1 and plasma osmolality predicting RT increase.

Conclusions:

• Hemodialysis-induced changes in ADMA, ET-1, oxidative stress, and osmotic stress impact ocular microcirculation and morphology.
• Optical coherence tomography angiography (OCTA) shows promise for evaluating microcirculation in hemodialysis patients.
• The study highlights the link between systemic hemodialysis effects and ocular vascular changes.