Details
Category: Volume 07 Issue 02 February 2019
Hits: 2713

Title: Fundus Changes in Chronic Kidney Disease Patients on Maintenance Haemodialysis

Authors: Brijesh Singh, Vivek Kumar Verma, Gaurav Agrawal, V.Vijayavarman, Geeta Singh

 DOI: https://dx.doi.org/10.18535/jmscr/v7i2.149

Abstract

Introduction: The vessel calibres of retinal arterioles decreased progressively with each chronic kidney disease stage of renal failure, suggesting that progression of renal dysfunction might be associated with retinal vessel constriction. Retinal microvascular abnormalities are common in chronic kidney disease because hypertension, renovascular disease, and diabetes account for more than half of all patients with renal failure.

Material and Methods: Total 128 patients having end stage chronic kidney disease on maintenance haemodialysis were examined. Patients of chronic kidney disease on maintenance hemodialysis were included and cases of reversible kidney injury were excluded. Direct and Indirect ophthalmoscopy along with history and examination was done.

Results: Total 128 patients, 96 (75%) male and 36 (25%) female were included. Male to female ratio was 4:1.Mean age of patients was 34.55±12.98 years with minimum age of 8 years and maximum age of 76 years. Most of the patients belong to age group 31-40 years. Minimum duration from initiation of dialysis therapy was 6 months and maximum duration was 9 years with average duration of 2.61±1.75 years. Most common fundus change was mild retinopathy found in 60 (46.88%) patients followed by moderate retinopathy found in 18 (14.06%) patients followed by severe retinopathy found in 8 (6.25%) patients. However fundus was normal in 42 (32.81%) patients. Most common type of retinopathy was hypertensive retinopathy found in 39 (30.47%) patients followed by mixed type of retinopathy 31 (24.22%) patients, diabetic retinopathy 12 (9.38%) patients, papilloedema found in 3 (2.34%) patients, macular oedema found in 1 (0.78%) patient. However no retinopathy found in 42 (32.81%) patients.

Conclusion: Hypertensive retinopathy was the most common type of retinopathy found in haemodialysis patients followed by mixed retinopathy, diabetic retinopathy, papilloedema and macular oedema. However no retinopathy found in about 1/3 of patients. In haemodialysis patients with retinopathy, majority had mild retinopathy.

Keywords: Fundus changes, Haemodialysis, Retinopathy, Papilloedema.

References

  1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney inter., Suppl. 2013; 3: 1–150.
  2. Rodolfo X, Bravo F, Rivero AP, et al. Community screening for hypertension, diabetes, chronic kidney disease and related risk factors. Clinical Kidney Journal. 2009;2:1173-76.
  3. Bhajracharya L, Shah DN, Raut KB, Koirala S. Ocular evaluation in patients with Chronic Renal Failure-A hospital based Study. Nepal Med Coll J. 2008;10(4):209-14.
  4. Ahmadi F, Nejad AM. Intraocular changes during haemodialysis and the role of blood glucose. Iran J Kidney Dis 2013;7(1):5-7.
  5. Rodrigo M, Premranjan.P, Richard W. Diabetes and Hypertension. Nature clinical Practice endocrinology and metabolism. 2007;3:667.
  6. Klein R, Klein BE. Vision disorders in diabetes. In: Diabetes in America, Bethesda, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. NIH publication. 1995: 293–338.
  7. Kofoed-Enevoldsen A, Jensen T, Borch-Johnsen K, Deckert T: Incidence of retinopathy in type I (insulin dependent) diabetes: Association with clinical nephropathy. J Diabet Complications.1987;1:96–99.
  8. Wong TY, Coresh J, Klein R, Muntner P, Couper DJ, SharrettAR, et al. Retinal microvascular abnormalities and renal dysfunction: The Atherosclerosis Risk in Communities study. J Am Soc Nephrol.2004; 15: 2469–76.
  9. Carlson EC. Scanning and transmission electron microscopic studies of normal and diabetic acellular glomerular and retinal microvessel basement membranes. Microsc Res Tech. 1994;28:165–177.
  10. Yau JW, Xie J, Kawasaki R, et al. Retinal arteriolar narrowing and subsequent development of CKD stage 3: the MultiEthnic Study of Atherosclerosis (MESA). Am J Kidney Dis. 2011;58:39–46
  11. Ooi QL, Tow FK, Deva R, et al. The microvasculature in chronic kidney disease. Clin J Am Soc Nephrol. 2011;6:1872–78
  12. Arici M: Walls J: End-stage renal disease, atherosclerosis, and cardiovascular mortality: Is C-reactive protein the missing link? Kidney Int.2001. 59: 407–414.
  13. Obialo CI. Cardiorenal consideration as a risk factor for heart failure. The American journal of cardiology. 2007 Mar 26;99(6):S21-4.
  14. Zoccali C. Traditional and emerging cardiovascular and renal risk factors: an epidemiologic perspective. Kidney international. 2006 Jul 1;70(1):26-33.
  15. Izzedine H, Bodaghi B, Launay-Vacher V, Deray G. Eye and kidney: from clinical findings to genetic explanations. Journal of the American Society of Nephrology. 2003 Feb 1;14(2):516-29.
  16. Appel GB, Cook HT, Hageman G, Jennette JC, Kashgarian M, Kirschfink M, et al. Membranoproliferative glomerulonephritis type II (dense deposit disease): an update. Journal of the American Society of Nephrology. 2005 May 1;16(5):1392-403.Watnick T, Germino G. From cilia to cyst. Nature genetics. 2003 Aug;34(4):355.
  17. Savige J, Liu J, Cabrera F D, Handa JT, Hageman GS, Wang YY, et al. The pathogenesis of the perimacular dot and fleck retinopathy in Alport syndrome. Invest Ophthalmol Vis Sci.2010;51:1621–27.
  18. Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al.; GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1459–544.
  19. Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015 May 16;385(9981):1975–82.
  20. Anand S, Shivashankar R, Ali MK, Kondal D, Binukumar B, Montez-Rath ME, et al. Prevalence of chronic kidney disease in two major Indian cities and projections for associated cardiovascular disease. Kidney Int. 2015;88:178–85.
  21. Malleswari B, Rahmathunnisa, Irshad. Eye Findings in Chronic Renal Failure Patients Undergoing Haemodialysis. International Journal of Contemporary Medical Research 2016;3(7):1912-1914.

Corresponding Author

Dr Vivek Kumar Verma

Lecturer, Dept of General Medicine, U.P. University of Medical Sciences, Saifai, Etawah, India 206130

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mob. No.: +917248792880