Reti̇nal and Choroi̇dal Mi̇crovascular Changes İn Hemodi̇alysi̇s and Peri̇toneal Di̇alysi̇s: A Comparati̇ve Oct and Oct-A Study

Why It Matters

Recognizing dialysis‑induced ocular changes enables clinicians to anticipate visual complications and apply non‑invasive imaging for timely monitoring, particularly since HD may impose greater short‑term retinal stress than PD.

Key Takeaways

• CMT and subfoveal choroidal thickness drop after dialysis.
• Blood pressure falls significantly during both HD and PD sessions.
• Retinal microvascular density unchanged despite structural thinning.
• HD shows larger CMT reduction than PD, linked to blood pressure swings.

Pulse Analysis

Dialysis patients are at heightened risk for ocular complications because the procedure directly influences systemic fluid balance and blood pressure. Optical coherence tomography (OCT) and its angiographic counterpart (OCTA) have emerged as frontline tools for detecting subtle retinal and choroidal alterations without invasive procedures. By capturing high‑resolution cross‑sections of the macula and choroid, these modalities provide clinicians with real‑time insight into how rapid fluid shifts during dialysis affect ocular structures.

The recent comparative study of 84 eyes revealed that both hemodialysis and peritoneal dialysis trigger measurable thinning of the central macula and subfoveal choroid, coinciding with notable drops in systolic and diastolic pressures. Interestingly, retinal microvascular parameters—vessel density and foveal avascular zone size—remained stable, suggesting that short‑term hemodynamic stress primarily impacts tissue thickness rather than capillary perfusion. Hemodialysis, characterized by more abrupt fluid removal, produced a larger change in macular thickness than peritoneal dialysis, underscoring the role of rapid blood‑pressure fluctuations in ocular remodeling.

For nephrologists and ophthalmologists, these findings highlight the value of integrating OCT/OCTA into routine dialysis care. Monitoring macular thickness could serve as an early warning system for patients susceptible to vision‑threatening conditions, enabling timely interventions such as adjusting ultrafiltration rates or prescribing protective ocular therapies. Moreover, the study opens avenues for longitudinal research to determine whether repeated structural shifts translate into long‑term visual outcomes, potentially shaping guidelines for multidisciplinary management of end‑stage renal disease patients.