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Adverse ocular effects of acetate hemodialysis
Insights
Acetate hemodialysis significantly decreased anterior chamber depth, potentially impacting ocular dynamics in glaucoma patients. Bicarbonate dialysis or mannitol administration may mitigate these effects.
Area of Science:
- Ophthalmology
- Nephrology
- Physiology
Background:
- Hemodialysis is a critical treatment for kidney failure.
- Understanding its systemic effects, including ocular dynamics, is important for patient management.
- Previous research has not fully elucidated the impact of different dialysate compositions on ocular parameters.
Purpose of the Study:
- To investigate the effects of acetate and bicarbonate hemodialysis on intraocular pressure (IOP) and anterior chamber depth (ACD).
- To determine if mannitol administration can preserve ACD during acetate hemodialysis.
- To identify potential risks associated with hemodialysis for patients with specific ocular conditions.
Main Methods:
- Serial measurements of IOP and ACD were performed in 10 stable hemodialysis patients.
- Dialysis was conducted using both acetate and bicarbonate buffers.
- Mannitol was administered concomitantly during some acetate dialysis sessions.
Main Results:
- Intraocular pressure (IOP) showed no significant changes during either dialysis type.
- Anterior chamber depth (ACD) significantly decreased during acetate hemodialysis.
- ACD was maintained during acetate hemodialysis when mannitol was administered.
- Bicarbonate hemodialysis did not result in significant changes in ACD.
Conclusions:
- Acetate hemodialysis may negatively affect ocular dynamics, particularly ACD, in susceptible individuals.
- Patients with glaucoma or recent ocular surgery may be at increased risk.
- Consideration of bicarbonate dialysate or mannitol administration is recommended for these patients during hemodialysis.
Abstract:
In order to better define ocular dynamics during hemodialysis, we studied intraocular pressure (IOP) and anterior chamber depth (ACD) serially during both acetate and bicarbonate hemodialysis in 10 stable hemodialysis patients. IOP did not change significantly in any patient during dialysis. In contrast, however, ACD decreased significantly during acetate but not bicarbonate dialysis. ACD could be maintained during acetate dialysis by concomitant administration of mannitol. We conclude that acetate dialysis might adversely affect ocular dynamics in susceptible patients with glaucoma or recent ocular surgery. In such individuals administration of mannitol or use of a bicarbonate dialysate should be considered.