The effect of long-term hemodialysis in end-stage kidney disease on macular and optic nerve head vasculature

Background End-stage kidney disease (ESKD) and eye problems are closely related, sharing common risk factors such as smoking, oxidative stress, diabetes, and hypertension. One of the most common causes of retinopathy is chronic renal disease, which can affect the vasculature of both retina and optic nerve. Purpose The aim of this study was to use optical coherence tomography angiography to assess the impact of long-term hemodialysis on the vasculature of the macula and optic nerve in patients with ESKD. Patients and methods This case–control observational prospective study included 36 eyes (36 patients) with ESKD who have been undergoing long-term hemodialysis, with varying durations of treatment and another 45 patients (90 eyes) of age-matched and sex-matched healthy controls. Using optical coherence tomography angiography, the vascular density (VD) was evaluated in several key areas of the retina including the macula, superficial capillary plexus (SCP), deep capillary plexus, and the radial peripapillary capillary (RPC) plexus. The findings were correlated with the urea reduction ratio, urea level, creatinine, and blood pressure, as well as the length of time these individuals were undergoing hemodialysis. Results The mean duration of hemodialysis was 6.11± 2.93 years. A statistically significant negative correlation was detected between the duration of hemodialysis and the macular SCP VD (%) in the perifovea ( r =−0.335, P =0.045), RPC VD (%) inside the disc ( r =−0.381, P =0.022), and the RPC in average ( r =−0.330, P =0.049). There was a statistically significant positive correlation between the VD of the SCP in the perifoveal section, RPC, and within the disc VD, and the urea reduction ratio ( r =0.379 and P =0.023, r =0.367 and P =0.028, and r =409 and P =0.013, respectively). Conclusion In patients with chronic kidney disease the density of the SCP, deep capillary plexus, and RPC plexus decreased as the duration of long-term hemodialysis increased.