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Abstract: PO0901

Ocular Dysequilibrium with Eye Pain During Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Adorno Rivera, Zaiyara, University of Florida Health, Jacksonville, Florida, United States
  • Hasan, Irtiza, University of Florida Health, Jacksonville, Florida, United States
  • Heilig, Charles W., University of Florida Health, Jacksonville, Florida, United States
Introduction

Eye complications may occur ESRD patients with glucoma. Hemodialysis (HD) may lower plasma osmolality at a faster rate than changes in ocular osmolality can adapt. Here we are presenting two cases of ESRD patients who repeatedly developed eye pain only during HD.

Case Description

A 54 y/o Hispanic male with ESRD, right eye blindness & glaucoma who developed right eye pain only during dialysis treatments. The maintenance HD prescription was with duration of 4.5 hr, blood flow rate (BFR) 450mL/min, dialysate flow 800 ml/min, Sodium (Na) 138 meq/L, potassium 2meq/L, Calcium 2.5 mEq/L, CO2 30mEq/L & an average 2L fluid removal per HD. His BP was 130-140mmHg/ 80-90 mmHg. In response to the eye symptoms, the BFR was reduced to 350 ml/min & time was increased to 4.5 hr. This change gave the patient initial relief from intradialytic eye pain. Eventually, Ophthalmologist was able to perform a surgical procedure which would eliminate the intradialytic eye pain. The 2nd case was a 64 y/o AA female with ESRD and glaucoma developed recurrent left eye pain with headaches only during HD. She went to her Ophthalmologist who renewed her glaucoma medications. This relieved her eye symptoms, and normalized her intraocular pressure off of dialysis. By taking her eye medications, she no longer developed eye pain or headaches during HD.

Discussion

Glaucoma is an ocular disorder where there is an increased IOP most commonly >22mmHg, this elevated pressure can cause blinding optic neuropathy. The current hypothesis for the rise of IOP during HD is related to an osmotic disequilibrium between the plasma & IO fluid, where the IO fluid is slightly hypertonic compared to plasma. Several medical therapies have been reported to mitigate the IOP increase during HD, such as the use of daily acetazolamide, mannitol infusion or 20% hyperosmolar glucose solution, or modified dialysis parameters with colloid infusion to raise plasma tonicity and decrease fluid shift during HD. However, these maneuvers have not been proven to relive ocular symptoms. In general, use of higher dialysate Na conc. at hemodialysis are not considered a long term solution to intradialytic ocular hypertension, due to the tendency for increaser fluid intake between HDs. Lower BFR with longer duration of hemodialysis treatments has been beneficial in some cases.