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ORIGINAL ARTICLE
Year : 1988  |  Volume : 36  |  Issue : 2  |  Page : 74-75

Intraocular pressure during haemodialysis


96-B, Kitchlew Nagar, Ludhiana-141 001, India

Correspondence Address:
R N Sud
96-B, Kitchlew Nagar, Ludhiana-141 001
India
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Source of Support: None, Conflict of Interest: None


PMID: 3235166

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  Abstract 

Intraocular pressure was measured before, at 2 hours & after haemodialysis in 75 uraemic patients of Indian origin, undergoing haemodialysis. There was no significant rise in intra­ocular pressure in these patients.


How to cite this article:
Sud R N, Chhabra S C, Sandhu J S, Bansal P K. Intraocular pressure during haemodialysis. Indian J Ophthalmol 1988;36:74-5

How to cite this URL:
Sud R N, Chhabra S C, Sandhu J S, Bansal P K. Intraocular pressure during haemodialysis. Indian J Ophthalmol [serial online] 1988 [cited 2020 Mar 29];36:74-5. Available from: http://www.ijo.in/text.asp?1988/36/2/74/26144



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  Introduction Top


Various reports have appeared in literature about changes in intraocular pressure during haemodialysis. Increase in intraocular pressure was observed by some authors in uraemic dogs & uraemic patients [1],[2],[3]. These studies dealt with long sessions of haemodialysis & it was suggested that increase in intraocular pressure evolved from a decrease in plasma osmolarity during haemodialysis & fluid shift into the eye. Ramsell et a1 [4] did not find a significant increase in intraocular pressure following 5 or 6-hour dialysis sessions, although intra­ocular pressure increased between the 2nd & 3 rd hour of dialysis. Rever et all & Gafter et al [6] reported no signi­ficant change in intraocular pressure following a 4 hour haemodialysis session with either acetate or bicarbonate in the dialysate, and they attributed it to a small reduction of osmolarity during 4 hours of dialysis. They came to the conclusion that the risk of severe rise in intraocular pressure following haemodialysis in uraemic patients seemed to be remote, but patients with occult glaucoma could meet with different risks on haemodialysis. Cecchin et al' in a study on 34 uraemic patients, identified 3 groups of patients on the basis of different tonometric readings group 1, no significant change in intraocular pressure, 25 patients; group 2, significant increase in intraocular pressure, 6 patients I e. 18%; and group 3, significant decrease in intraocular pressure, 3 patients. They concluded that a significant increase in intraocular pressure during haemodialysis is not a remote possibility & in cases with significant increase in intraocular pressure during haemodialysis, a possibility of aqueous humour outflow obstruction has to be kept in mind. To the best of our knowledge, no such study has so far been conducted in India, Therefore, we decided to conduct a study on intraocular pressure during haemodialysis in Indian subjects with chronic renal disease.


  Material & Methods Top


75 patients of Indian origin with end stage renal disease were included in the study. There were 61 males & 14 females. The age varied from 19-75 years, the average being 48.7 years. Mera crystal flow 1.0 H hollow fibre dialysers were used. The dialysis machines were Centry­ 2 and Drake Willoclc, and all the patients received acetate dialysis with a mean blood flow of 200 ml/ minn and dialysate flow of 500 ml/min. The duration of dialysie was 4 hours. Intraocular pressure was measured with a Schiotz tonometer in both eyes before, at 2 hours, and soon after haemodialysis. Blood samples were withdrawn before, at 2 hours & at the end of dialysis; & serum potassium, chloride, urea, creatinine & glucose were measured using standard bio-chemical methods. Serum osmolarity was calculated with the serum sodium, potassium, urea & glucose levels, using the



Since the intraocular pressure readings for both eyes were similar in almost every instance, mean value of the two eyes was determined for data analysis.


  Results Top


75 Indian patients with end stage renal disease were included in the study. There were 61 males & 14 females. The age varied from 19-7 5 years, with mean age of 48.7 years. The initial mean intraocular pressure was 16.8 ± 0.29 mm Hg, at 2 hours 16.9 ± 0.34 mm Hg and [Table - 1] 16.7 ± 0.33 mm Hg. There was no statistically significant difference between the 3 readings. (P is less than 0.05). Interestingly, in one patient with a border­line intraocular pressure in one eye & raised intraocular pressure in the other eye, there was a considerable rise (10.1 mm Hg in one eye & 7.7 mm Hg in the other eye) in intraocular pressure at 2 hours & comparatively smaller rise (5.6 mm Hg in one eye & 3.7 mm Hg in the other eye) at the end of dialysis.

Initial mean serum osmolarity was 342.9 ± 3.41 mOsm/ ha t 2 hours, 328.8 ± 3.83 mOsm/ L; and 320.4 ± 3.87 mOsm/ L at the end of dialysis [Table - 2]. There was only a marginal decrease in serum osmolarity at 2 hours; but a singificant decrease at the end of dialysis (P is less than 0.05).


  Discussion Top


Sitprija et al[1] observed a significant increase in intra­ocular pressure in uraemic dogs, during haemodialysis. . Watson & Greenwood' found a rise in intraocular pressure following haemodialysis In human beings. Bum' also noted a repeated rise in intraocular pressure in one eye of a patient during haemodialysis in 13 other dialysis patients a rise in intraocular pressure, though not gross was noted. It was suggested by them that a rise in intraocular pressure occurred as a result of a decrease in plasma osmolarity during haemodialysis & a conse­quent increase in aqueous formation; it was advised that the state of intraocular pressure should be considered when planning a long term haemodialysis & possibility of outflow obstruction should be kept in mind. The above studies dealt with long sessions of haemodialysis.

Ramsell et al [4] did not find a significant rise in intra­ocular pressure following 5-or 6-hour dialysis sessions, although there was a significant rise in intraocular pressure between the 2nd & 3rd hour of dialysis Rever et al [5] & Gafter et al [6] observed no significant increase in intraocular pressure, following a 4 hour haemodialysis in chronic uraemic patients. However Gafter et a1[6] found a rise in. intraocular pressure in one patient with glaucoma, and they concluded that the risk of severe rise in intraocular pressure following haemodialysis is only a remote possibility but patients with occult glaucoma could meet with' different risks on haemodialysis. Cecchin et a1 [7], in a study on 34 patients with end stage renal failure on 4-hour dialysis, found a significant rise in intraocular pressure in 6 (18%) patients & concluded that a rise in intraocular pressure during haemodialysis is relatively frequent & not remote. They suggested that the state of intraocular pressure should be considered while planning long term haemodialysis, and the possi­bility of an obstruction of aqueous humor outflow should be kept in mind in patients showing a significant increase in intraocular pressure during dialysis, and acetazolamide should be used cautiously as it may produce a severe metabolic acidosis, and drugs other than acetazolamide, such as pilocarpine or mannitol should be used when required.

In our study on 75 Indian uraemic patients on 4 hours haemodialysis, no significant rise in intraocular pres­sure was found at 2 hours & at the end Serum osmolarity showed a significant decrease at the end of dialysis, and only a marginal decrease at 2 hours. In one of our cases, with a borderline intraocular pressure in one eye & raised intraocular pressure in the other eye, there was a significant rise in intraocular pressure at 2 hours but at the end the rise was only marginal Our findings correspond with those of Ramsell et al[4] & Rever et al[5] & we are also of the view that there is only a remote possibility of a significant rise in intraocular pressure during haemodialysis, but it may be quite different in cases of occult glaucoma, as illustrated by one of our cases, and one case each of Burn [3] & Gafter et al [6]; if a rise occur it should be managed not with diamoz but with other drugs like pilocarpine and mannitol We would further like to suggest that intraocular pressure should be monitored in all the patients of uraemia, undergoing haemodialysis.

 
  References Top

1.
Sitprija, V.; Holmes J.R; Ellis, P.D.. Changes in intraocular pressure during haemodialysis. Invest Ophth. 3, 273-284, 1964.  Back to cited text no. 1
    
2.
Watson, AG. and Greenwood, W.R : Studies on the intraocular pressure during haemodialvsis Cand. J. Ophthal. 301-307, 1966.  Back to cited text no. 2
    
3.
Bum, RA: Intraocular pressure during haemodialysis Br. J. Ophthal 57, 511-513, 1973.  Back to cited text no. 3
    
4.
Ramsell, J.R, Ellis, P.P., and Peterson, C.A : Intraocular pressure changes during haemodialysis. Am J. Ophthal. 72, 926-930, 1971.  Back to cited text no. 4
    
5.
Rever, R; Fox L; Bar-Khayim, Y.; and Nissenson, A : Adverse ocular effects of acetate haemodialysis. Kidney int 19, 157, 1981.  Back to cited text no. 5
    
6.
Gafter, U.; Pinkas, M.; Hirsh, J.; Levi, J.; and Savir, H : Intraocular pressure in uraemic patients on chronic haemodialysis Nephro. 40, 74-75, 1985.  Back to cited text no. 6
    
7.
Ceechin, E.; De Marchi, S.; and Tesio, F.: Intraocular pressure and haemodialysis. Nephron. 43, 73-74, 1986.  Back to cited text no. 7
    



 
 
    Tables

  [Table - 1], [Table - 2]



 

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Introduction
Material & Methods
Results
Discussion
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