Choroidal Microcirculatory Responses to Hemodialysis in Patients With Diabetic Nephropathy and Retinopathy

To investigate choroidal hemodynamic changes after a hemodialysis (HD) session in the initiation versus maintenance phases in patients with diabetic nephropathy (DN) and diabetic retinopathy (DR).

This study included 38 eyes of 20 patients with DN-related end-stage renal disease and DR, stratified into initiation (first HD session; 12 eyes) and maintenance (26 eyes) groups. Choroidal hemodynamics were quantified using laser speckle flowgraphy (LSFG). Macular mean blur rate (M_MBR; index of blood flow) parameters, macular beat strength (M_BS; index of pulsatility), and central choroidal thickness (CCT) were evaluated.

In the initiation group, M_MBR parameters significantly decreased after HD, whereas mean changes in M_BS and CCT were not significant. A comparable significant reduction in ocular perfusion pressure was observed in both cohorts. The initiation group exhibited significantly greater reductions in choroidal circulation and thickness. Higher ultrafiltration volume was linked to greater flow pulsatility reductions in the initiation group, with no volume-dependent correlation in the maintenance group.

Choroidal circulation exhibits dialysis phase-dependent hemodynamic patterns. The initiation phase is characterized by volume-dependent flow pulsatility reductions, whereas the maintenance phase displays an attenuated response, indicating vascular adaptation. LSFG-derived monitoring may serve as a noninvasive biomarker for assessing microcirculatory responses.