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Abstract #92702 Published in IGR 22-1
Changes in Intraocular Pressure during Hemodialysis: A Meta-analysis
Chen SH; Lu DW; Ku WC; Chuang LH; Ferng SH; Chen YJ; Lu YH; Chai PYJournal of Glaucoma 2021; 0:
PRCIS: Acetate dialysate causes elevation of intradialytic intraocular pressure (IOP) and contributed to the rise of IOP in the early years of hemodialysis. Glaucoma, narrow-angle, or impaired aqueous outflow is another moderator causing a rise of intradialytic IOP. PURPOSE: Severe intraocular pressure (IOP) elevation during hemodialysis (HD) has been described in many case reports. However, the results of primary studies are conflicting. This meta-analysis examined the impact of HD on IOP and explored the potential moderators. METHODS: Medline, PubMed, Embase, Web of Science, and Cochrane were systematically searched. Before-after studies reporting the change of IOP during HD were included. Intradialytic IOP changes were calculated based on four different definitions: highest-baseline, lowest-baseline, max-baseline, and end-baseline IOP difference. Standardized mean difference (SMD) was pooled using the random-effects model. RESULTS: 53 studies involving 1903 participants and 2845 eyes were included. Overall data pooling showed no significant rise in intradialytic IOP. However, subgroup analysis showed an intradialytic IOP rise before 1986 (SMD 0.593; 95% CI 0.169 to1.018; max-baseline IOP difference as representative; most studies using acetate dialysate), no change between 1986 and 2005 (using both acetate and bicarbonate), and a decline after 2005 (SMD -0.222; 95% CI -0.385 to -0.063; entirely using bicarbonate). Multivariable meta-regression showed only the type of dialysate, but not publication year or other potential factors, as a significant moderator. Glaucoma was found to be another significant moderator independent of the dialysate effect in bivariate meta-regression. CONCLUSIONS: IOP rose in the early years of HD due to the effect of acetate dialysate, but this phenomenon is no longer a clinical problem since the substitution of acetate with bicarbonate dialysate. However, physicians should still be cautious of potential IOP changes in the HD population with glaucoma.
Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan Department of Ophthalmology, Tri-service General Hospital, Taipei, Taiwan Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan Division of Nephrology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle Harrisburg, Harrisburg, Pennsylvania, USA School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan Department of Pharmacy, Chang Gung Memorial Hospital, Keelung, Taiwan.
Full articleClassification:
6.1.3 Factors affecting IOP (Part of: 6 Clinical examination methods > 6.1 Intraocular pressure measurement; factors affecting IOP)
9.4.15 Glaucoma in relation to systemic disease (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
